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PubMed1982

Genetic factors in puerperal affective psychoses.

The hypothesis that puerperal affective psychosis (PAP) is genetically related to manic-depressive disorder was tested by comparing the morbidity risks for puerperal and non-puerperal affective disorders in the relatives of 17 PAP subjects and 20 parous manic-depressives (PMD) with no history of puerperal illness. The risk for affective disorder (mania, depression or suicide) and puerperal affective disorder was the same in the two groups of relatives and the test hypothesis was accepted, although the sample size was small. The frequencies of HLA-A, B and C locus antigens, nine blood group antigens and 10 red blood cell isoenzymes were not significantly different in the PAP and PMD subjects, showing that in this series genetic markers do not distinguish puerperal from non-puerperal affective psychoses.

Adult↗
PubMed1990

Puerperal and cycloid psychoses. Results of a retrospective study.

Puerperal psychoses are traditionally considered to be nosologically unspecific. They are defined exclusively by their occurrence close to delivery. Attempts to further diagnostically subdivide puerperal psychoses have been prevented to date by the influence of Kraepelin's dichotomy. New possibilities of nosological differentiation arose out of Kasanin's (1933) description of schizoaffective psychoses and out of Leonhard's differentiated nosology (1986). The objective of the present, retrospective study was to apply Leonhard's nosology to 42 postpartal psychoses. Five diagnostic groups could be identified: 6 cases of manic-depressive disorder, 7 cases of pure depression, 8 cases of pure melancholia, 2 cases of unsystematic schizophrenia, and 19 cases of cycloid psychoses. For this reason we consider that the concept of the cycloid psychoses is appropriate for the characterization of a large proportion of childbed psychoses.

Adult↗
PubMed1994

[Emotional and psychiatric postpartum complications].

The three emotional and psychiatric complications of post-partum are: puerperal psychoses; post-natal depressions; and post-partum blues. Puerperal psychoses (prevalence = 0.2%) are now well known in their clinical and therapeutic aspects. Much less known are the post-natal depressions, in spite of their high incidence (10 to 20% of women). The consequences upon the life of patients and mother-child bond are still ignored. These depressions are too rarely adequately treated. Finally, post-partum blues is to be recognized for a preventive purpose, its intensity being a predictive factor of post-natal depression.

Depressive Disorder↗
PubMed2002

Postpartum psychoses: prognosis, risk factors, and treatment.

Puerperal psychoses do not represent a nosological entity, but rather a selection of puerperally triggered "ordinary" functional psychoses with cycloid psychoses predominating and schizophrenias occurring very rarely. The prognosis is basically favorable concerning symptom remission and social and occupational functioning. However, there is a considerable frequency of relapses and an increased suicide rate. The most important risk factors for an episode of a puerperal psychosis are being primiparous and having suffered a previous episode of a psychosis, particularly a cycloid psychosis. Controlled treatment studies up to now are absent. Case studies suggest in acute episodes the efficacy of a symptom-oriented pharmacologic treatment where ablactation is recommended. With respect to prophylactic treatment some authors propose to apply lithium in late pregnancy or immediately after delivery. Because of its possible teratogenic effects and the altogether rather sparse data, the authors however cannot recommend the use of lithium during pregnancy. Applying estradiol after delivery may be beneficial and safe, but further studies are necessary to clarify these issues.

Adult↗
PubMed1996

[Postpartum psychoses. A case report].

The puerperal period is a critical one in the life of a woman, due to the numerous changes which occur at biological and psychological levels and also at the level of relationships. Various disturbances of a psychiatric nature may emerge during this period which represents a "risky" phase from a psycho-pathological point of view. Among some of these disturbances, so-called "puerperal psychoses", there is an uncertain nosographic connection. According to some authors, these psychoses could be distinct nosographic events, while others prefer to include them in psychotic disturbances which have already been classified. From this point of view the puerperal period would be a stressful event. Risk factors would be a first birth, previous psychotic puerperal episodes, inherited serious psychiatric disturbances and caesarean section. The therapy used in the case of such disturbances must take into account many aspects and implications which don't exclusively concern the new mother but which also look significantly at the newborn baby, and the patient's family circumstances. All this implies the necessity for a close collaboration between specialists in different medical areas (psychiatry and obstetrics). Particular attention should be given to the type of disturbed relationship which can occur between the mother and the new born child. The analysis of our case has stimulated many reflections from a clinical, therapeutic and prognostic point of view, and as a result we tent to agree with published material on the subject.

Adult↗
PubMed2001

Oestrogen withdrawal associated psychoses.

OBJECTIVE: Oestrogen withdrawal has been hypothesized as playing a causal role in puerperal psychoses. However, oestrogen withdrawal exists in conditions others than puerperium. We searched the published case reports where a decrease in oestrogen levels not occurring during puerperium was associated with a psychotic disorder, in order to evaluate the relevance of this hypothesis. These cases were defined as oestrogen withdrawal associated psychoses. METHOD: A systematic research of the literature was conducted for the period 1960-2000. RESULTS: We identified 26 observations reporting an association between a psychotic disorder and a phase of oestrogen withdrawal. Psychotic episodes were short and reversible with recurrences reported when oestrogen withdrawal recurred. Puerperal psychosis was frequently reported in the history of patients. CONCLUSION: The oestrogen withdrawal hypothesis can be extended to certain psychotic episodes not occurring during in puerperium. This provides an additional argument for the clinical relevance of oestrogen withdrawal in puerperal and related psychoses.

Adolescent↗
PubMed1998

Puerperal and menstrual psychoses: the proposal of a unitary etiological hypothesis.

Puerperal and menstrual psychoses are both uncommon disorders and the occurrence of both in individual patients suggests the possibility of a common underlying pathogenesis. In this paper two cases are reported, the literature is reviewed and a unifying etiological hypothesis is postulated in which precipitous reductions in the brain estrogen environment precipitate episodes of psychosis in predisposed individuals. In the case of puerperal psychosis, estrogen cascade follows a lengthy period of sustained high brain estrogen environment; in menstrual psychosis, it is postulated that the occurrence in at least some cases of anovulatory menstrual cycles, wherein high levels of relatively unopposed estrogens are maintained until the next ovulatory cycle, play a role in priming the central nervous system prior to premenstrual estrogen cascade. Further research in this area using more sensitive techniques to follow hormonal fluctuation and mental state is called for.

Adult↗
PubMedDate not supplied

Psychiatric disorders in the puerperium. A follow-up study.

The outcome of puerperal psychoses in a group of 66 patients was studied 10-11 years after the initial illness. The present health of the study group and a control non-puerperal group was compared using the Health Sickness Rating Scale (HSRS). The majority of the puerperal psychotics were primigravida. The rate of positive family history of psychiatric illness was similar in both groups. There was no significant difference in the scores of both group on the H.S.R.S. A startling finding was a mortality of 1 in 5 amongst the puerperal psychotics. These and other findings are discussed.

Female↗
PubMed1986

Postpartum psychiatric disorders.

Postpartum blues, postpartum neurotic depression and puerperal psychoses have distinct clinical features; they affect women in all social classes and in all cultures, and despite numerous studies they have not been linked definitively with any biologic or psychosocial variables. The only possible exception is puerperal psychosis, which emerges much more often in women with a personal or family history of a bipolar affective disorder than in women without, a finding that probably explains the reluctance of some researchers to recognize puerperal psychotic episodes as distinct from psychotic episodes at other times. If postpartum blues last longer than 2 weeks and are disabling they are classified as neurotic depression and warrant treatment, often requiring both psychosocial approaches and psychotropic drug therapy. Antidepressants, major tranquillizers, electroconvulsive therapy and lithium have proved effective in the treatment of postpartum psychoses, depending on the symptoms. Both lithium and diazepam have been reported to cause deleterious side effects on breast-fed infants, and as the side effects of other psychotropic drugs given to a nursing mother are imperfectly understood, bottle feeding seems prudent.

Adult↗
PubMed1977

Psychiatric disorders including drug therapy and addiction.

The follow-up of 238 women with antenatal and puerperal psychiatric illness indicated that drugs used for these conditions may affect the outcome of pregnancy. This may be due to the fact that psychotropic drugs have an effect on hormonal balances and neurotransmitters. Although antenatal and puerperal psychoses have symptoms which relate them to the main psychiatric categories, they are definite clinical entities (Bucknill and Luke, 1874; Hamilton, 1962); this no doubt reflects the major social and hormonal changes which occur during pregnancy and the puerperium.

Acute Disease↗
PubMed1975

Puerperal psychosis: a follow-up study of a joint mother and baby treatment programme.

A cohort of 54 mothers with puerperal psychoses admitted between 1965 and 1969 to a joint mother and baby short stay treatment programme is reported with a follow-up at the end of 1973. The outcomes indicate that this treatment routine is as satisfactory as other programmes. Those who, for various reasons, did not complete the joint programme of treatment did not do so well.

Adolescent↗
PubMed1993

[Psychiatric disorders during maternity. 16 cases].

This study, originally intended to identify the status of puerperal psychoses, has revealed today, on the basis of a review of 16 requests for psychiatric opinions coming from departments of gynecology and obstetrics in Limoges, that this acute psychiatric situation plays only a tiny role in psychiatric psychology associated with pregnancy. Post-partum disorders, with the exception of "baby-blues", were seen infrequently, the majority of cases involving psychological difficulties with or without behavioural disturbances or somatic decompensation, but the onset of which could have been predictable if it had been possible to identify the risk factors of psychological decompensation which our study was able to demonstrate.

Female↗
PubMed1981

[Joint hospitalisation of mentally ill mothers and their children (author's transl)].

Joint admission of mothers with puerperal psychoses and their babies to the psychiatric hospital has proved successful. This not only avoids possible damage to the child and to the mother-child relationship as a result of prolonged separation; it appears that in fact the mother herself recovers more rapidly and is more self-assured in managing the child after her discharge from hospital. This, in turn, reduces the danger of a relapse and helps to stabilize the mother-child relationship. Joint admission of mother and infant is advisable whenever the neurotic signs shown by the mother centre around the relation to her baby. Joint admission is usually technically easy, while making exacting demands on the nursing staff. It requires detailed planning and organisation coupled with continual and close supervision. Under these conditions, joint hospitalisation of mother and child represents a widening of our therapeutic possibilities.

Adult↗
PubMed2001

Brain preparations for maternity--adaptive changes in behavioral and neuroendocrine systems during pregnancy and lactation. An overview.

Pregnancy, parturition and lactation comprise a continuum of adaptive changes necessary for the development and maintenance of the offspring. The endocrine changes that are driven by the conceptus and are essential for the maintenance of pregnancy and are involved in the preparations for motherhood are outlined. These changes include large increases in the secretion of sex steroid hormones, and the secretion of peptide hormones that are unique to pregnancy. The ability of these pregnancy hormones to alter several aspects of brain function in pregnancy is considered, and the adaptive importance of some of these changes is discussed, for example in metabolic and body fluid adjustments, and the induction of maternal behavior. The importance of sex steroids in determining the timing of the various adaptive changes in preparing for parturition and maternal behavior is emphasized, and the concept that the actions of prolactin and oxytocin, quintessential mammalian motherhood neuropeptides, can serve to coordinate a spectrum of adaptive changes is discussed. The part played by oxytocin neurons and their regulatory mechanisms is reviewed to illustrate how neural systems involved in maternity are prepared in pregnancy via changes in phenotype, synaptic organization and in the relative importance of their different inputs, to function optimally when needed. For oxytocin neurons secreting from the posterior pituitary, important in parturition and essential in lactation, these changes include mechanisms to restrain their premature activation, and adaptations to support synchronized burst firing for pulsatile oxytocin secretion in response to stimulation via afferents from the birth canal, olfactory system or suckled nipples. Within the brain, expression of oxytocin receptors permits centrally released oxytocin to facilitate the expression of maternal behavior. Changes in other neuroendocrine systems are similarly extensive, leading to lactation, suppression of ovulation, reduced stress responses and increased appetite; these changes in lactation are driven by the suckling stimulus. The possible link between these adaptations and changes in cognition and mood in pregnancy and post partum are considered, as well as the dysfunctions that lead to common problems of depression and puerperal psychoses.

Adaptation, Physiological↗
PubMed1998

Postpartum psychosis and postpartum thyroiditis.

The term postpartum psychosis refers to a group of severe and heterogeneous disorders with psychotic symptoms that occur most frequently in the context of a mood disorder during the postpartum period. We report a case of 'postpartum psychosis' possibly associated with postpartum thyroiditis in a 29 year-old woman. The appearance of psychotic symptoms was chronologically related to the onset of postpartum thyroiditis and resolution of psychosis synchronized with the achievement of biochemical euthyroidism. The patient had typical symptoms of 'classic postpartum psychosis' (a historical term not included in DSM-IV, but used frequently by many physicians to describe diagnostic and therapeutic challenges posed by puerperal psychoses). Three months postpartum, the patient began to believe that she was pregnant with the Christ child, although she was not pregnant. Her delusions resolved around the 'pregnancy' and harm to her 'unborn' child. She also believed that her child (Jesus) was going to be killed. Other key symptoms included hallucinations, mixed mood symptoms, agitation and transient disorientation. Her DSM-IV diagnosis on admission was major depression with psychotic features and her discharge diagnosis (most likely diagnosis) was psychotic disorder due to thyrotoxicosis caused by postpartum thyroiditis. The differential diagnosis of co-occurring psychosis and postpartum thyroiditis can be examined relative to four possibilities: (1) psychosis due to thyrotoxicosis caused by postpartum thyroiditis; (2) a coincidence (no association between psychosis and postpartum thyroiditis); (3) precipitation of psychotic symptoms and disorientation related to a postpartum thyroiditis in a woman with a pre-existing mood disorder; or (4) both psychosis and thyroiditis caused by a pre-existing defect in autoimmunity. The authors stress the importance of early diagnosis and prompt treatment of postpartum psychosis. They discuss the indications for thyroid screening in postpartum psychoses. Further research is needed to clarify the nosology and mechanisms of severe postpartum disorders and to elucidate treatment-relevant and etiologically-distinct subsets of postpartum psychosis.

Adult↗