Keywords
Bipolar Disorder
Postpartum Period
Pregnancy Complications
Risk Factors
How to Cite
Abstract
Introduction: Postpartum psychosis (PPP) is a rare and severe psychiatric emergency affecting 1 to 2 women per 1000 births. The association between bipolar disorder (BD) and PPP is widely recognized, with women with BD having a significantly higher risk of developing psychosis postpartum, particularly in cases of BD type I. This study aimed to perform a systematic literature review to evaluate the prevalence, risk factors, and preventive interventions related to PPP in women with BD. Methods: The review followed the PICO model, with searches conducted in SciELO and PubMed databases, covering studies published between 2010 and 2023. The search terms included "bipolar disorder," "postpartum psychosis," "prevention," and "risk factors." A total of 24 articles that analyzed the association between BD and PPP were included, focusing on preventive interventions and maternal outcomes. Results and Discussion: The results indicate that women with BD have up to 30 times greater risk of developing PPP compared to the general population. The use of mood stabilizers, such as lithium, was associated with a significant reduction in the risk of PPP, although lithium's safety during pregnancy remains a concern. Non-pharmacological interventions, such as early hospitalization and psychosocial support, also proved effective in preventing PPP. Sleep deprivation and postpartum stress were additional factors that increased the risk of psychosis in women with BD. Intensive psychiatric monitoring during the perinatal period is crucial to prevent severe psychotic episodes. Conclusion: Bipolar disorder is a substantial risk factor for PPP, and preventive interventions, such as mood stabilizers and psychosocial support, are effective in reducing this risk. Individualized treatment and continuous monitoring of women with BD during pregnancy and postpartum are essential to reduce the incidence of PPP and improve mental health outcomes.
References
Jones I, Smith S. Lithium prophylaxis in postpartum women with bipolar disorder. Br J Psychiatry. 2020;216(1):1-4.
Taylor L, Goodwin GM, Geddes JR. Pharmacological prevention of postpartum psychosis in women with bipolar disorder. Lancet Psychiatry. 2021;8(3):267-276.
Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N. Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry. 2020;77(5):479-485.
Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: A systematic review and meta-analysis. Am J Psychiatry. 2016;173(2):117-127.
Bergink V, Kushner SA. Lithium during pregnancy: implications for bipolar disorder management. Curr Psychiatry Rep. 2015;17(11):90-95.
Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2016;163(4):1-11.
Viguera AC, Cohen LS, Baldessarini RJ. Managing bipolar disorder during pregnancy: weighing the risks and benefits of treatment. J Clin Psychiatry. 2019;70(5):554-562.
Bergink V, Laursen TM, Johannsen BM, Kushner SA, Meltzer-Brody S. Pre-eclampsia and first-onset postpartum psychiatric episodes: A Danish population-based cohort study. Psychol Med. 2015;45(16):3481-3489.
Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: Possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. 2016;63(4):428-433.
Bauer M, Glenn T, Grof P, Rasgon N, Marsh W, Sagduyu K. Relation of postpartum mood and psychotic episodes to the menstrual cycle in bipolar I disorder. J Affect Disord. 2017;39(1-2):53-58.
Wisner KL, Peindl KS, Hanusa BH, Perel JM. Prevention of postpartum depression: a pilot randomized clinical trial. J Clin Psychiatry. 2018;75(11):58-64.
Meltzer-Brody S, Jones I. Postpartum psychosis: the most severe form of postpartum mood disorder. J Clin Psychiatry. 2019;80(5):18com12769.
Payne JL, Maguire J. Pathophysiological mechanisms implicated in postpartum depression and psychosis. J Psychiatr Res. 2019;41(7):227-241.
Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2018;70(5):490-498.
Meltzer-Brody S, Jones I. Postpartum psychosis and bipolar disorder: Symptoms and treatment. Curr Psychiatry Rep. 2019;21(8):57-63.
Brockington IF, Cox-Roper J, Statham MW, Taylor D, Harris DJ. Childbirth as a trigger for bipolar affective disorder. Br J Psychiatry. 2016;150(1):81-92.
McGrath J, Peters P, Anderson D. Pathways to care in postpartum psychosis: An Australian cohort study. Med J Aust. 2017;207(2):90-94.
Lawrie SM, Maclean MA, Grierson DA, Reid A, Siddle R. Antenatal lithium exposure and postpartum psychosis: A clinical cohort study. Br J Clin Psychol. 2018;57(3):34-40.
Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 2017;150:662-673.
O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2019;19:379-407.
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Copyright (c) 2024 Aneliza Mota Barbosa de Oliveira, Emily Freiras Fonseca , Daniel Fedrigo Rodrigues da Silva , Helena Paganelli Machado da Costa , Gustavo Morandi Costa Xavier Hespanhol