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Letter to the Editor: Postpartum psychosis and pre-eclamptic toxaemia: a reply

Published online by Cambridge University Press:  13 June 2016

V. Bergink
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
T. M. Laursen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark CIRRAU, Centre for Integrated Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
B. M. W. Johannsen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
S. A. Kushner
Affiliation:
Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
S. Meltzer-Brody
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
T. Munk-Olsen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
Corresponding
E-mail address:
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Abstract

Type
Correspondence
Copyright
Copyright © Cambridge University Press 2016 

Brockington (Reference Brockington2016) highlights the co-occurrence of eclampsia and postpartum psychosis as an important diagnostic consideration. We agree and have described in our previous work the importance of performing thorough physical, neurological and laboratory examinations of every patient with first-onset postpartum psychosis as this might lead to a diagnosis with treatable causes and co-morbidities (Bergink et al. Reference Bergink, Burgerhout, Koorengevel, Kamperman, Hoogendijk, Lambregtse-van den Berg and Kushner2015b ). In addition to eclampsia, clinicians should consider the postpartum occurrence of autoimmune disorders (e.g. thyroiditis), encephalitis (e.g. NMDA encephalitis), infections (e.g. endometritis, mastitis) and rare inborn errors of metabolism.

Most women with first-onset postpartum psychosis will exhibit one of two disease courses (Bergink et al. Reference Bergink, Boyce and Munk-Olsen2015a ): an isolated postpartum psychosis with vulnerability to affective psychosis only after birth or postpartum psychosis as an expression of bipolar mood disorder with non-perinatal episodes (Chaudron & Pies, Reference Chaudron and Pies2003; Di Florio et al. Reference Di Florio, Munk-Olsen and Berginkin press). The diagnostic criteria for puerperal bipolar disorder and Donkin psychosis as described by Brockington (Reference Brockington2016) have neither been validated nor field tested, and therefore are not currently suitable for implementation in population-based epidemiological studies.

References

Bergink, V, Boyce, P, Munk-Olsen, T (2015 a). Postpartum psychosis: a valuable misnomer. Australian and New Zealand Journal of Psychiatry 49, 102103. CrossRefGoogle ScholarPubMed
Bergink, V, Burgerhout, KM, Koorengevel, KM, Kamperman, AM, Hoogendijk, WJ, Lambregtse-van den Berg, MP, Kushner, SA (2015 b). Treatment of psychosis and mania in the postpartum period. American Journal of Psychiatry 172, 115123.CrossRefGoogle ScholarPubMed
Brockington, I (2016). Postpartum psychosis and pre-eclamptic toxaemia [Letter]. Psychological Medicine. doi: 10.1017/S0033291716001173.CrossRefGoogle Scholar
Chaudron, LH, Pies, RW (2003). The relationship between postpartum psychosis and bipolar disorder: a review. Journal of Clinical Psychiatry 64, 12841292.CrossRefGoogle ScholarPubMed
Di Florio, A, Munk-Olsen, T, Bergink, V (in press). The birth of a psychiatric orphan disorder: postpartum psychosis. Lancet Psychiatry.Google Scholar
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