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 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.

vertical extent of the dissection, which aVected only the final prepetrosal segment of the internal carotid artery at level C2. The dissection thus spared the XIIth nerve, located at a lower level (third cervical vertebra), and the Vth and VIIth nerves, located at a higher level. Furthermore, the small lateral extent of the mural haematoma would seem to explain why the Xth and XIth nerves were spared.

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.