ABSTRACT
Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the relevant literature to highlight the broad differential diagnosis of postpartum psychosis with atypical features. Recommendations for evaluation, diagnosis, and treatment of patients with complex neuropsychiatric symptoms in the postpartum period are discussed. This case of postpartum psychosis with malignant catatonia highlights the role of immunology in the development and treatment of postpartum psychosis and the need for future research to more accurately define the etiology and best tailor treatment.
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References (24)
- VanderKruik R, Barreix M, Chou D, et al; Maternal Morbidity Working Group. The global prevalence of postpartum psychosis: a systematic review. BMC Psychiatry. 2017;17(1):272. PubMed CrossRef
- Bergink V, Rasgon N, Wisner KL. Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry. 2016;173(12):1179–1188. PubMed CrossRef
- Osborne LM. Recognizing and managing postpartum psychosis: a clinical guide for obstetric providers. Obstet Gynecol Clin North Am. 2018;45(3):455–468. PubMed CrossRef
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013.
- Kamperman AM, Veldman-Hoek MJ, Wesseloo R, et al. Phenotypical characteristics of postpartum psychosis: a clinical cohort study. Bipolar Disord. 2017;19(6):450–457. PubMed CrossRef
- Spinelli M. Postpartum psychosis: a diagnosis for the DSMV. Arch Women Ment Health. 2021;24(5):817–822. PubMed CrossRef
- Bush G, Fink M, Petrides G, et al. Catatonia, I: rating scale and standardized examination. Acta Psychiatr Scand. 1996;93(2):129–136. PubMed CrossRef
- Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Womens Health (Larchmt). 2006;15(4):352–368. PubMed CrossRef
- Upadhyaya SK, Sharma A, Raval CM. Postpartum psychosis: risk factors identification. N Am J Med Sci. 2014;6(6):274–277. PubMed
- Brockington I. Suicide and filicide in postpartum psychosis. Arch Women Ment Health. 2017;20(1):63–69. PubMed CrossRef
- Yan L, Zhang S, Huang X, et al. Clinical study of autonomic dysfunction in patients with anti-NMDA receptor encephalitis. Front Neurol. 2021;12:609750. PubMed CrossRef
- Hazelgrove K. The role of the immune system in postpartum psychosis. Brain Behav Immun Health. 2021;18:100359. PubMed CrossRef
- Qiu K, He Q, Chen X, et al. Pregnancy-related immune changes and demyelinating diseases of the central nervous system. Front Neurol. 2019;10:1070. PubMed CrossRef
- Schiller CE, Meltzer-Brody S, Rubinow DR. The role of reproductive hormones in postpartum depression. CNS Spectr. 2015;20(1):48–59. PubMed CrossRef
- Wieck A, Kumar R, Hirst AD, et al. Increased sensitivity of dopamine receptors and recurrence of affective psychosis after childbirth. BMJ. 1991;303(6803):613–616. PubMed CrossRef
- Ford B, McDonald A, Srinivasan S. Anti-NMDA receptor encephalitis: a case study and illness overview. Drugs Context. 2019;8:212589. PubMed CrossRef
- Bergink V, Armangue T, Titulaer MJ, et al. Autoimmune encephalitis in postpartum psychosis. Am J Psychiatry. 2015;172(9):901–908. PubMed CrossRef
- Zhang T, Duan Y, Ye J, et al. Brain MRI characteristics of patients with anti-n-methyl-d-aspartate receptor encephalitis and their associations with 2-year clinical outcome. AJNR Am J Neuroradiol. 2018;39(5):824–829. PubMed CrossRef
- Gresa-Arribas N, Titulaer MJ, Torrents A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014;13(2):167–177. PubMed CrossRef
- Lee SK, Lee S-T. The laboratory diagnosis of autoimmune encephalitis. J Epilepsy Res. 2016;6(2):45–50. PubMed CrossRef
- Abboud H, Probasco JC, Irani S, et al; Autoimmune Encephalitis Alliance Clinicians Network. Autoimmune encephalitis: proposed best practice recommendations for diagnosis and acute management. J Neurol Neurosurg Psychiatry. 2021;92(7):757–768. PubMed CrossRef
- Bordonne M, Chawki MB, Doyen M, et al. Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis. Eur J Nucl Med Mol Imaging. 2021;48(12):3847–3858. PubMed CrossRef
- Scheibe F, Prüss H, Mengel AM, et al. Bortezomib for treatment of therapy-refractory anti-NMDA receptor encephalitis. Neurology. 2017;88(4):366–370. PubMed CrossRef
- Blinder T, Lewerenz J. Cerebrospinal fluid findings in patients with autoimmune encephalitis-a systematic analysis. Front Neurol. 2019;10:804. PubMed CrossRef
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