Osborne, L. M. (2018). Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers. Obstetrics and gynecology clinics of North America, 45(3), 455-468. https://doi.org/10.1016/j.ogc.2018.04.005
Osborne LM. Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers. Obstetrics and gynecology clinics of North America. 2018;45(3):455-468. doi:10.1016/j.ogc.2018.04.005
Osborne, Lauren M. "Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers." Obstetrics and gynecology clinics of North America, vol. 45, no. 3, 2018, pp. 455-468.
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RRM Academy Synopsis
Postpartum psychosis affects 1 to 2 in 1,000 women and is an emergency
A 2018 clinical review for obstetric providers explains that postpartum psychosis is a psychiatric emergency affecting 1 to 2 out of 1,000 women. Onset is usually sudden, within two weeks of birth. The review names a personal history of bipolar disorder as the strongest single risk factor.
Key Findings
Postpartum psychosis affects 1-2 per 1,000 women, and onset is typically sudden, within the first two weeks postpartum.
Among 130 consecutive cases, symptom profiles were mania or agitation (34%), depression or anxiety (41%) and atypical or mixed (25%); 72% had abnormal thought content.
Of parous women with known bipolar disorder, 20-30% experienced postpartum psychosis, while only 33% of women presenting with it had a prior psychiatric history.
Autoimmune thyroiditis was present in 19% of women with postpartum psychosis and 5% of controls.
In a 64-woman treatment study, 47 of the remaining 48 women remitted once lithium was added, and nearly 80% kept full remission at 9 months postpartum.
Interpretation
This is a narrative clinical review. The author gathers published studies into guidance for obstetric providers. The author notes that the disorder is rare and randomizing women in a psychiatric emergency is ethically hard, so treatment evidence relies on small observational studies. The 64-woman Dutch study is the largest treatment study to date. The review describes strong evidence that these episodes run in families.
RRM Context
Restorative reproductive medicine treats the postpartum period as part of a woman's reproductive health. The review calls immune dysregulation, including more autoimmune thyroiditis, an active research area. It also discusses sleep loss and a vulnerability to hormone shifts in some women. The author writes that current evidence does not support hormones to treat or prevent the illness.
Our editorial summary of this paper, not the article's abstract.
Abstract
Postpartum psychosis is a psychiatric emergency that affects 1 to 2 per 1000 women. Key clinical features include mood fluctuation, abnormal thoughts or behaviors, and confusion. Women with a history of bipolar disorder are at heightened risk, as are first-time mothers; current research on the causes focuses on biological triggers, such as immune dysregulation. Women with postpartum psychosis require inpatient hospitalization and should be treated with lithium, antipsychotics, and benzodiazepines.
