The Relationship Between Postpartum Psychosis and Bipolar Disorder: A Review
J Clin Psychiatry 2003;64(11):1284-1292
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The evidence for a spectrum of
bipolar disorders is mounting. Of particular interest and
importance is the evolution and recurrence of bipolar disorder in
the postpartum period and its relationship to postpartum
psychosis. Understanding whether such a phenomenological link
exists has diagnostic, prognostic, and treatment implications.
Objectives: A comprehensive review of (1) the
literature regarding the relationships between postpartum
psychosis and bipolar affective disorder, (2) the data regarding
prophylactic treatment and acute management of postpartum
psychosis and bipolar disorder in the puerperium, and (3)
critical areas for future research.
Study Design: MEDLINE and PubMed (1966-2002)
databases were searched for English-language articles using the
keywords postpartum/puerperal depression, puerperal/postpartum
psychosis, bipolar disorder, lithium, anticonvulsants, antipsychotics, and breastfeeding.
Results: Evidence from studies of women with a
history of bipolar disorder, longitudinal studies of women with
puerperal episodes of psychosis, and family studies support a
link between postpartum psychosis and bipolar disorder.
Conclusions: Understanding the relationship
between postpartum psychosis and bipolar disorder has
implications for perinatal and long-term treatment. Prophylactic
treatment of women with bipolar disorder and/or a history of
postpartum psychosis may be indicated. Epidemiological, genetic,
and pharmacologic research must be completed to understand,
prevent, and adequately treat postpartum psychosis.