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Tijdschrift voor Psychiatrie 57 (2015) 1, 25 - 33


Postpartum psychosis in clinical practice: diagnostic considerations, treatment and prevention

R. Wesseloo, K.M. Burgerhout, K.M. Koorengevel, V. Bergink

background Postpartum psychosis is a severe psychiatric disease which occurs in the early postpartum period after 1 - 2 per 1000 deliveries. Patients with a history of postpartum psychosis and/or bipolar disorder are at extreme high risk of relapse postpartum.
aim To discuss diagnostic considerations, treatment and the prevention of postpartum psychosis, and to give clinical recommendations. method Literature search with PubMed and relevant textbooks.
results Inpatient psychiatric admission enables the clinician to ensure the safety of mother and baby, perform physical and neurological examination, and laboratory analysis to exclude known organic causes for acute psychosis. Antipsychotic and lithium and ECT are effective treatment options. Women with postpartum psychosis compared to those with bipolar disorder had a substantial difference in their clinical outcomes and prophylaxis requirements.
conclusion Inpatient screening for somatic (co)morbidity is essential in patients with postpartum psychosis. With adequate treatment, almost all patients achieve complete remission and the prognosis is optimistic. Initiation of prophylaxis immediately postpartum in women with a history of postpartum psychosis with lithium was highly effective for preventing postpartum relapse.

keywords bipolar disorder, diagnosis, postpartum psychosis, prevention, treatment