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Role of estradiol in puerperal psychosis
1Department of Psychiatry, Helsinki City Hospital, Finland. antti.ahokas@kolumbus.fi
Rationale:
Postpartum period has been considered a time of increased risk for the development of psychiatric disorders with long-lasting adverse consequences. Psychoses are the most severe of these illnesses and can be resistant to psychiatric medication.
Objective:
We present two women with puerperal psychosis who had low serum estradiol, were refractory to neuroleptic medication but responded successfully to estradiol treatment.
Methods:
Serum estradiol concentration was measured at baseline and during the treatment with sublingual 17-beta estradiol. Treatment effect was evaluated using Brief Psychiatric Rating Scale.
Results:
Both patients had a low pretreatment estradiol concentration (28 and 54 pmol/l). During treatment with estradiol, the rise in serum estradiol coincided with a decline of psychotic symptoms. Discontinuation of estradiol treatment resulted in a rebound of florid psychotic symptoms in both cases.
Conclusions:
Estradiol may have a causal relation to postpartum psychosis and significance in the treatment of this illness.
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