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Review
. 2023 Oct;37(10):960-970.
doi: 10.1177/02698811231181573. Epub 2023 Jul 29.

Postpartum psychosis: A proposed treatment algorithm

Chaitra Jairaj  1   2   3 , Gertrude Seneviratne  1   4 , Veerle Bergink  5   6   7 , Iris E Sommer  8 , Paola Dazzan  9   10
Affiliations
Review

Postpartum psychosis: A proposed treatment algorithm

Chaitra Jairaj et al. J Psychopharmacol. 2023 Oct.

Abstract

Background: Postpartum psychosis (PPP) is a psychiatric emergency that generally warrants acute inpatient care. PPP is marked by the sudden onset of affective and psychotic symptoms with a rapid deterioration in mental state. Evidence suggests that PPP is a discrete disorder on the bipolar disorder spectrum with a distinct treatment profile and prognosis.

Methods: We conducted a PubMed database search for various terms involving PPP and its treatment and included peer-reviewed articles published in English.

Objective: To provide a treatment algorithm for the management of PPP based on available evidence.

Results: Pharmacological therapy is the mainstay of PPP management in the acute phase. Evidence points to a combination of antipsychotics and lithium in the acute treatment of PPP. Electroconvulsive therapy can offer a rapid treatment response where required. Lithium appears to have the best evidence for relapse prevention and prophylaxis in PPP. Psychoeducation is essential and psychosocial interventions used in bipolar disorder may be effective in PPP.

Conclusion: Early detection and prompt treatment with antipsychotics and lithium, followed by maintenance treatment with lithium, is associated with a favourable prognosis in PPP.

Keywords: Postpartum psychosis; prophylaxis; treatment.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: P Dazzan’s research in postpartum psychosis has been supported by the Brain and Behaviour Research Foundation, the Psychiatry Research Trust and the Medical Research Foundation. P Dazzan has received speaker’s fees from Lundbeck and Janssen. C Jairaj, G Seneviratne, V Bergink, I Sommer do not report any conflicts of interest.

Figures

Figure 1.
Figure 1.
Treatment algorithm for PPP. CBT: cognitive behavioural therapy; ECT: electroconvulsive therapy; PPP: postpartum psychosis.
See this image and copyright information in PMC

References

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