Postpartum Psychosis: A Proposed Treatment Algorithm

Chaitra Jairaj; Gertrude Seneviratne; Veerle Bergink; Iris E Sommer; Paola Dazzan

doi:10.1176/appi.focus.23021033

Postpartum Psychosis: A Proposed Treatment Algorithm

Focus (Am Psychiatr Publ). 2024 Jan;22(1):131-142. doi: 10.1176/appi.focus.23021033. Epub 2024 Jan 12.

Authors

Chaitra Jairaj¹, Gertrude Seneviratne¹, Veerle Bergink¹, Iris E Sommer¹, Paola Dazzan¹

Affiliation

¹ South London and Maudsley NHS Foundation Trust, London, UK (Jairaj, Seneviratne); Trinity College Dublin, Dublin, Ireland (Jairaj); National Maternity Hospital, Dublin, Ireland (Jairaj); Royal College of Psychiatrists, London, UK (Seneviratne); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands (Bergink); Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands (Sommer); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Dazzan); National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK (Dazzan).

PMID: 38694161
PMCID: PMC11058922 (available on 2025-01-01)
DOI: 10.1176/appi.focus.23021033

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.Reprinted from J Psychopharmacol 2023; 37:960-970, with permission from Sage Journals. Copyright © 2023.

Keywords: Postpartum psychosis; prophylaxis; treatment.