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Response to sleep deprivation in three women with postpartum psychosis
T B Strouse1, M P Szuba, L R Baxter
1Department of Psychiatry and Biobehavioral Sciences, University of California, School of Medicine, Los Angeles.
Background:
Postpartum psychotic disorders are rare and poorly understood phenomena occurring after approximately 1 in 2000 births. Increasing attention has been given to the concept of postpartum psychosis as an affective spectrum disorder. We sought to characterize the responses to sleep deprivation of three women with postpartum psychotic and mood symptoms.
Method:
Three hospitalized postpartum women with no prior history of psychotic disorder were treated according to a partial sleep deprivation protocol. Each patient was awakened at 2:00 a.m. and kept awake until 9:00 p.m. the following night. A full and an abbreviated Hamilton Rating Scale for Depression (HAM-D) were completed for each patient before and after partial sleep deprivation.
Results:
Two of the three patients became transiently manic and the third became hypomanic after sleep deprivation. HAM-D scores decreased drastically for each patient. After recovery sleep, each patient de-escalated but required further treatment with mood-stabilizing agents.
Conclusion:
These findings suggest that postpartum psychosis in our patients may represent a variant of bipolar affective disorder.