Pharmacotherapy of postpartum psychosis

The term postpartum psychosis (PP) is not a discrete nosological entity but rather, refers to a group of heterogeneous disorders that share the common features of the presence of psychosis and onset of symptoms during the postpartum period. Although there remains a debate regarding its diagnostic status, PP is generally considered as belonging to the bipolar spectrum. The prognosis for the individual episodes is considered generally favourable but it is a potentially serious illness due to the increased risk of suicide and infanticide. Furthermore, puerperal and non-puerperal recurrences are quite common. There is paucity of controlled trials in the acute and prophylactic treatment of PP and the data are limited largely to the use of lithium and oestrogen. Strategies for the clinical management of PP should include early identification of women at risk; close monitoring of mood state during pregnancy, prompt recognition of impending psychosis and aggressive pharmacotherapy. In general, treatment for PP is essentially the same as for similar non-puerperal episodes.