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Postpartum Psychosis: A Review of Pharmacological Therapy Options

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Postpartum Psikoz: Farmakolojik Tedavi Seçeneklerinin Derlemesi

Yazar: Barış ÖRS1

Corresponding author
1Barış ÖRS, Ankara Üniversitesi Tıp Fakültesi Dönem 6, Ankara, Türkiye
E-mail: orsbaris1@gmail.com

ABSTRACT

Postpartum psychosis is a severe postpartum mental health emergency characterized by mood swings, abnormal thinking or behavior, and confusion. Factors such as hormonal and psychological changes in the mother during pregnancy and the postpartum period, stress and a psychiatric disorder play an essential role in the development of postpartum psychosis, together with a genetic predisposition. Although this condition is most common in patients who have been or will be diagnosed with bipolar disorder, it may also occur less frequently in women with psychosis, schizophrenia, or major depression with schizoaffective disorder. In some patients, this situation may remain isolated in the postpartum period and not progress to any mood-destroying or psychotic disorders in the future. In a group of patients, this psychosis may manifest itself in the future. This psychiatric emergency can cause serious harm to both the mother and the baby, so postpartum psychosis should be recognized and treated as quickly as possible. There is no single guideline for the treatment of postpartum psychosis. Therefore, the treatment must be meticulously chosen by the clinicians according to the clinical characteristics of each patient. According to the data obtained from many clinics in recent years, it has been seen that the most effective treatments are antipsychotics, lithium, mood stabilizers, antidepressants, benzodiazepines, and electroconvulsive therapy (ECT). Therefore, facilitating and accelerating the clinician’s choice among these options will significantly contribute to managing postpartum psychosis. This review presents an analysis of current pharmacological treatment modalities in the treatment of postpartum psychosis.

Keywords: Postpartum, Pregnancy, Psychosis.

ÖZET

Doğum sonrası psikoz, duygudurum dalgalanmaları, anormal düşünce veya davranışlar ve konfüzyon ile karakterize, doğum sonrası gelişen ciddi bir ruh sağlığı acili durumudur. Gebelik ve postpartum dönemde annede gelişen hormonal ve psikolojik değişim, stres, sahip olunan bir psikiyatrik rahatsızlık gibi faktörler, genetik yatkınlıkla birlikte doğum sonrası psikozun gelişiminde önemli bir rol oynar. Bu durum en sık bipolar bozukluk tanısı almış veya alacak hastalarda görülmekle beraber, psikoza sahip, şizofreni ya da şizoaffektif bozukluğu olan majör depresyonlu kadınlarda da daha az sıklıkta ortaya çıkabilir. Bir kısım hastada bu durum postpartum dönemde izole kalabilir ve ileride herhangi bir duygudurum bozan veya psikotik rahatsızlıklara ilerlemez ve hastalık başka bir atakla seyretmezken bir grup hastada bu oluşan psikoz kendini ileride de gösterebilir ve şizofreni gibi psikotik rahatsızlıklar dâhil kişinin yaşamını etkileyen bir duruma evrilebilir. Bu psikiyatrik acil durum hem anneye hem de bebeğe ciddi zararlar verebilmektedir, bu nedenle postpartum psikoz, klinisyenler tarafından en hızlı bir şekilde tanınmalı ve tedavisi en kısa sürede uygulanmalıdır. Doğum sonrası psikozun tedavisinde tek bir kılavuz yoktur. Dolayısıyla hastalara uygulanacak tedavinin, klinisyenler tarafından her hastanın klinik özelliklerine göre titizlikle seçilmesi önem arz etmektedir. Son yıllarda birçok kliniklerden elde edilen verilere göre en efektif tedavilerin, antipsikotikler, lityum, duygudurum düzenleyiciler, benzodiyazepinler ve elektrokonvülsif tedavi (EKT) olduğu görülmüştür. Bu nedenle bu seçenekler arasından klinisyenlerin seçim yapmasının kolaylaştırılması ve hızlandırılması, bu denli ciddi bir acil durum olan doğum sonrası psikozun yönetilmesine oldukça katkı sağlayacaktır. Bu derleme, doğum sonrası psikoz tedavisinde güncel farmakolojik tedavi modalitelerinin bir analizini sunmaktadır.

Anahtar Kelimeler: Doğum sonrası, Gebelik, Psikoz.

How to Cite (APA 7)

Ors, B. (2023). Postpartum Psychosis: A Review of Pharmacological Therapy Options. Health Sciences Student Journal, 3(1), 14-22. https://www.healthssj.com/postpartum-psychosis-a-review-of-pharmacological-therapy-options/

KAYNAKLAR

  1. VanderKruik R., Barreix M., Chou D., Allen T., Say L., Cohen L.S., Barbour K., Cecatti J.G., Cottler S., Fawole O., et al. The global prevalence of postpartum psychosis: A systematic review. BMC Psychiatry. 2017;17:1–9.
  2. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA. 2006;296:2582-9.
  3. Shapiro S, Nass J. Postpartum psychosis in the male. Psychopathology. 1986;19(3):138-42.
  4. Rhode A, Marneros A. Postpartum psychoses: onset and long-term course. Psychopathology 1993; 26: 203-209.
  5. Kırkpınar İ, Çayköylü A, Coşkun İ, Özer H. Postpartum psikoz gelişen kadınların demografik ve klinik özellikleri. Dusunen Adam The Journal of Psychiatry and Neurological Sciences. 1996;9:35-40.
  6. Garfield P, Kent A, Paykel ES, Creighton FJ, Jacobson RR. Outcome of postpartum disorders: a 10 year follow-up of hospital admissions. Acta Psychiatr Scand. 2004 Jun;109(6):434-9.
  7. Kendell R.E., Chalmers J.C., Platz C. Epidemiology of puerperal psychoses. Br. J. Psychiatry. 1987;150:662–673.
  8. Lewis KJ, Foster RG, Jones IR. Is sleep disruption a trigger for postpartum psychosis? Br J Psychiatry. 2016 May;208(5):409-11.
  9. Jones, I.; Hamshere, M.; Nangle, J.M.; Bennett, P.; Green, E.; Heron, J.; Segurado, R.; Lambert, D.; Holmans, P.; Corvin, A.; et al. Bipolar affective puerperal psychosis: Genome-wide significant evidence for linkage to chromosome 16. Am. J. Psychiatry 2007, 164, 1099–1104.
  10. Enns GM, O’Brien WE, Kobayashi K, Shinzawa H, Pellegrino JE. Postpartum “psychosis” in mild argininosuccinate synthetase deficiency. Obstet Gynecol. 2005 May;105(5 Pt 2):1244-6.
  11. Weigelt, K.; Bergink, V.; Burgerhout, K.M.; Pescatori, M.; Wijkhuijs, A.; Drexhage, H.A. Down-regulation of inflammationprotective microRNAs 146a and 212 in monocytes of patients with postpartum psychosis. Brain. Behav. Immun. 2013, 29, 147–155.
  12. Gentile, S., 2005. The role of estrogen therapy in postpartum psychiatric disorders: an update. CNS Spectr. 10 (12), 944–952.
  13. Nguyen K, Mukona LT, Nalbandyan L, Yar N, St Fleur G, Mukona L, Hernandez E, Lamberty N. Peripartum Complications as Risk Factors for Postpartum Psychosis: A Systemic Review. Cureus. 2022 Sep 16;14(9):e29224.
  14. Bider EN, Coker JL. Postpartum psychosis and SARS-CoV-2 infection: is there a correlation? Arch Womens Ment Health. 2021 Dec;24(6):1051-1054.
  15. Kamperman AM, et al., Phenotypical characteristics of postpartum psychosis: A clinical cohort study. Bipolar Disord, 2017. 19(6): p. 450–457.
  16. Oates M. Suicide: The leading cause of maternal death. Br. J. Psychiatry J. Ment. Sci. 2003;183:279–281.
  17. Campbell J, Matoff-Stepp S, Velez ML, Cox HH, Laughon K. Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence. J Womens Health (Larchmt). 2021 Feb;30(2):236-244.
  18. Mughal S, Azhar Y, Siddiqui W. Postpartum Depression. 2022 Oct 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.
  19. Rezaie-Keikhaie K, Arbabshastan ME, Rafiemanesh H, Amirshahi M, Ostadkelayeh SM, Arbabisarjou A. Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period. J Obstet Gynecol Neonatal Nurs. 2020 Mar;49(2):127-136.
  20. O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014 Jan;28(1):3-12.
  21. Di Florio A, et al., Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry, 2013. 70(2): p. 168–75.
  22. Raza SK, Raza S. Postpartum Psychosis. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544304/
  23. Robertson E, Jones I, Haque S, Holder R, Craddock N. Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis. The British Journal of Psychiatry. 2005;186(3):258–259.
  24. Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. Am J Psychiatry. 2012 Jun;169(6):609-15.
  25. Bergink V, Rasgon N, Wisner KL. Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. Am J Psychiatry. 2016 Dec 1;173(12):1179-1188.
  26. Doucet S, Jones I, Letourneau N, Dennis CL, Blackmore ER. Interventions for the prevention and treatment of postpartum psychosis: a systematic review. Arch Womens Ment Health. 2011;14(2):89–98.
  27. Boyce P, Barriball E. Puerperal psychosis. Archives of women’s mental health. 2010;13(1):45–47.
  28. Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev. 2013 Mar-Apr;10(3):308-17.
  29. Poels EMP, Bijma HH, Galbally M, Bergink V. Lithium during pregnancy and after delivery: a review. Int J Bipolar Disord. 2018 Dec 2;6(1):26.
  30. Anderson PO. Antidepressants and Breastfeeding. Breastfeed Med. 2021 Jan;16(1):5-7.
  31. Nishimura A, Furugen A, Umazume T, Kitamura S, Soma M, Noshiro K, Takekuma Y, Sugawara M, Iseki K, Kobayashi M. Benzodiazepine Concentrations in the Breast Milk and Plasma of Nursing Mothers: Estimation of Relative Infant Dose. Breastfeed Med. 2021 May;16(5):424-431.
  32. Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2013 Jul;16(6):1205-18.
  33. Teodorescu A, Ifteni P, Dragan A, Moga MA, Miron AA, Dima L. Clozapine Efficacy in a Case of Severe Treatment-Resistant Postpartum Psychosis. Risk Manag Healthc Policy. 2021 Feb 12;14:555-559.
  34. Friedman SH, Reed E, Ross NE. Postpartum Psychosis. Curr Psychiatry Rep. 2023 Feb;25(2):65-72
  35. Payne, J., (2022. In S.Marder, & M.Friedman (Eds), UptoDate.). Treatment of postpartum psychosis https://www.uptodate.com/contents/treatment-of-postpartum-psychosis#H3106518439 (accessed Jan 2023).
  36. Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Womens Health (Larchmt). 2006 May;15(4):352-68.
  37. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011;7(1):28-34.
  38. Stewart DE (1988) Prophylactic lithium in postpartum affective psychosis. J Nerv Ment Dis 176:485–489.
  39. Fornaro M, Maritan E, Ferranti R, Zaninotto L, Miola A, Anastasia A, Murru A, Solé E, Stubbs B, Carvalho AF, Serretti A, Vieta E, Fusar-Poli P, McGuire P, Young AH, Dazzan P, Vigod SN, Correll CU, Solmi M. Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes. Am J Psychiatry. 2020 Jan 1;177(1):76-92.
  40. Bergink V, Burgerhout KM, Koorengevel KM, Kamperman AM, Hoogendijk WJ,  Lambregtse-van den Berg MP, Kushner SA. Treatment of psychosis and mania in the postpartum period. Am J Psychiatry. 2015 Feb 1;172(2):115-23
  41. Foct A, Kellner CH. Electroconvulsive therapy (ECT) in the treatment of      postpartum psychosis. J ECT. 2012 Mar;28:31-3
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