Treatment of Psychosis and Mania in the Postpartum Period

Bergink, Veerle; Burgerhout, Karin M.; Koorengevel, Kathelijne M.; Kamperman, Astrid M.; Hoogendijk, Witte J.G.; Berg, Mijke P. Lambregtse–van den; Kushner, Steven A.

doi:10.1176/appi.ajp.2014.13121652

Cited by 113 publications

(102 citation statements)

References 49 publications

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“…However, because of extrapyramidal side effects, haloperidol was switched to olanzapine. After 2 weeks, she required addition of lithium according to our structured treatment protocol (21). Over the next month, she developed a subclinical hypothyroiditis, which was diagnosed as thyroid peroxidase antibody-positive autoimmune thyroiditis.…”

Section: Resultsmentioning

confidence: 99%

Autoimmune Encephalitis in Postpartum Psychosis

Bergink

Armangué

Titulaer

et al. 2015

AJP

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Objective Significant immunological alterations have been observed in women with first-onset affective psychosis during the postpartum period. Recent studies have highlighted the possibility that a subset of patients with first-onset severe psychiatric episodes might suffer from undiagnosed autoimmune encephalitis. Therefore, the authors performed a three-step immunohistochemistry-based screening for CNS autoantibodies in a large cohort of patients with postpartum psychosis and matched postpartum comparison subjects. Method Ninety-six consecutive patients with postpartum psychosis and 64 healthy postpartum women were included. Screening for antibodies in patient serum was performed using immunohistochemistry. Samples showing any staining were further examined by immunocytochemistry using live hippocampal neurons and cell-based assays to test for anti-N-methyl-d-aspartate (NMDA) receptor antibodies. Cell-based assays for all other known CNS antigens were performed in those samples with immunocytochemistry labeling but negative for NMDA receptor antibodies. Results Four patients (4%) with neuropil labeling suggestive for extracellular antigen reactivity were identified. Serum samples from all four patients showed clear extracellular labeling of live hippocampal neurons. Two women had the specific staining pattern characteristic for anti-NMDA receptor antibody positivity, which was confirmed by cell-based assays. Neither patient with anti-NMDA receptor antibody positivity had evidence of an ovarian teratoma. The other two patients tested negative by cell-based assays for all known CNS antigens. None of the matched postpartum comparison subjects had confirmed neuronal surface antibodies. The two patients with anti-NMDA receptor antibodies both showed extrapyramidal symptoms following initiation of treatment with low-dose haloperidol. Conclusions In patients with acute psychosis during the postpartum period, systematic screening for anti-NMDA receptor autoantibodies should be considered. The acute onset of severe atypical psychiatric symptoms in young female patients should raise the index of suspicion for anti-NMDA receptor encephalitis, particularly in the setting of neurological symptoms, including extrapyramidal side effects of antipsychotic treatment.

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Section: Resultsmentioning

confidence: 99%

Autoimmune Encephalitis in Postpartum Psychosis

Bergink

Armangué

Titulaer

et al. 2015

AJP

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“…The risk of postpartum relapse is highest in women who also experienced a mood episode during pregnancy and those who are not on prophylactic treatment 535. Despite the high prevalence of postpartum episodes, there is a dearth of studies investigating the efficacy of medications during this period.…”

Section: Specific Populationsmentioning

confidence: 99%

“…Despite the high prevalence of postpartum episodes, there is a dearth of studies investigating the efficacy of medications during this period. There is evidence of efficacy of benzodiazepines, antipsychotics, and lithium for postpartum mania,535 and quetiapine for postpartum bipolar depression (level 4) 536. There are no studies of psychotherapy in the acute or preventative treatment of bipolar postpartum depression 537…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…All patients were diagnosed according to DSM-IV-TR (First, 1996) using the Structural Clinical Interview for Disease (SCID -1/P research version). The clinical characteristics of this cohort have been previously reported (Bergink et al, 2015b).…”

Section: Participantsmentioning

confidence: 99%