At three centres, 21 women at high risk for puerperal psychosis were given prophylactic lithium carbonate late in the third trimester of pregnancy or immediately after delivery. Only two of the women had a recurrence of their psychotic illness while on prophylactic lithium. One woman given lithium during third trimester had an unexplained stillbirth. Although a larger sample in a carefully controlled study is still required, there now seems to be grounds for the use of prophylactic lithium immediately after delivery in women not breastfeeding who have previously suffered from either puerperal psychosis or bipolar disorder.

The risk of malignant transformation seems to increase with the grade of dysplasia, although percentages between studies are highly dissimilar. The wide variety and overlapping 95% CIs make it difficult to formulate a strong recommendation. However, moderate dysplasia is more prone for malignant transformation than previously thought, which might influence follow-up and treatment decisions in the future. © 2015 Wiley Periodicals, Head Neck 38: E2284-E2290, 2016.

The case registers of the patients admitted consecutively to the mother-and-baby unit of the Rotterdam University Hospital between 1967 and 1989 were studied in detail and classified according to the Research Diagnostic Criteria (RDC). The temporal relationship between delivery and the onset of symptoms for the different RDC categories is presented. A comparison is made with the classical concept of puerperal psychosis as it is held in the Netherlands. According to RDC, postpartum psychosis has 3 main phenomenological manifestations: affective, schizoaffective and unspecified functional psychosis. The classical concept of puerperal psychosis largely overlaps the RDC categories schizoaffective disorder and unspecified functional psychosis. The implications regarding the nosology of postpartum psychosis are discussed.

Antidepressant effects of mirtazapine and imipramine were compared in a randomized, double blind, fixed blood-level study with in-patients in a single centre. Patients with a DSM-III-R diagnosis of major depression and a Hamilton (17-item) score of ≥ 18 were selected. After a drug-free and a placebowashout period of 7 days in total, 107 patients still fulfilling the HRSD criterion of ≥ 18, started on active treatment. The dose was adjusted to a predefined fixed blood level to avoid suboptimal dosing of imipramine. Concomitant psychotropic medication was administered only in a few cases because of intolerable anxiety or intolerable psychotic symptoms. Eight patients dropped out and two were excluded from analyses because of non-compliance; 97 completed the study. According to the main response criterion (50% or more reduction on the HRSD score) 11/51 (21.6%) patients responded on mirtazapine and 23 /46 (50 %) on imipramine after 4 weeks' treatment on the predefined blood level. Such a dramatic difference in efficacy between antidepressants has not often been reported before. The selection of (severely ill) in-patients, including those with suicidal or psychotic features, may have significance in this respect. Optimization of treatment with the reference drug imipramine through blood level control, exclusion of non-compliance for both drugs, exclusion of most concomitant medication and a low drop-out rate may also have contributed. It is concluded that imipramine is superior to mirtazapine in the patient population studied.

The clinical features and symptoms of postpartum psychoses are presented in relation to the classification according to the Research Diagnostic Criteria (RDC) and the concept of "puerperal psychosis". A number of symptoms, ie confusional symptoms, depersonalization, misrecognitions and the "kaleidoscopic" picture are shown to be prominent features. In schizoaffective disorder and unspecified functional psychosis a higher frequency of confusional symptoms, misrecognitions, thematic delusions and a "kaleidoscopic" course of illness was found compared to schizophrenia, mania or depression. The findings of this study support a special status for postpartum psychosis and suggest a link with the concept of cycloid psychosis. In the management of postpartum mental disorder the risk of child-directed aggression, suicide and sudden relapses into psychosis requires special attention.