[Importance of vitamin B1 in the therapy of post-partum neurasthenias and psychoses].
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Recent case reports of postpartum psychosis are reviewed, which suggest hypotheses for the aetiology of this disease. The main themes are: The relationship to manic depression. Premenstrual relapse. Prepartum onset. Onset after miscarriage or evacuation of a trophoblastic tumour. Onset after bromocriptine treatment. Attempts to treat this and related psychoses by progesterone. Apomorphine growth hormone challenge tests.
More than half of the psychoses which develop a few weeks after delivery are manic depressive psychoses. A very limited fraction are schizoaffective psychoses. Up to one fourth are difficult to classify on account of dominating symptoms such as disturbances of consciousness and schizophrenic symptoms. No organic etiology has been found for these disturbances of consciousness. In British investigations, the hypothesis has been presented that these psychoses with atypical symptomatology represent a less serious variant of manic depressive psychoses. This question can only be solved by investigations concerning the etiology of manic depressive psychoses. In the present article, the hypothesis is presented that these psychoses may be reactive psychoses. Investigations concerning the etiology of reactive psychoses are necessary.
The hypothesis that post-partum psychoses are predominantly mixed affective disorders was tested by administering the dexamethasone suppression test (DST) to seven puerperal psychotics, six puerperal depressives and comparison groups of non-puerperal psychotic and depressed women. The hypothesis received support from the finding that two-third of the puerperal patients had positive DSTs versus one-third of similar non-puerperal patients. An 80% rate of positive DSTs in 19 normal women 5 days post-partum, however, suggested this was an invalid interpretation of this finding, particularly as the majority of these tests returned to normal when repeated several weeks later.
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