Wochenbettpsychosen – klinische, neurobiologische und psychosoziale Aspekte

Abstract

Psychotic illnesses in women after giving birth to a baby are called puerperal or postpartum psychoses. These puerperal psychoses mainly manifest in the first days till few weeks after delivery. On a clinical level they must be differentiated from so called "postpartum blues" that may be considered a basic psychobiological adjustment reaction without a proper state as disorder on the one hand, from postnatal depressions that typically manifest later and are without psychotic symptoms on the other. Cycloid, schizoaffective, manic or psychotic-depressive symptoms prevail in puerperal psychoses. Cycloid psychoses during the postpartum period seem to be linked more pronouncedly to bipolar affective than to schizophrenic disorders in the further course of illness as is indicated by clinical follow up and family studies. There is a major risk of psychotic relapses both after further pregnancies and also in other non-index periods. A subgroup of affected women, however, will not suffer from any further psychoses. In respect of aetiopathogenesis research literature underlines major neurobiological influences outweighing psychosocial factors. A significant link to the neuroendocrine changes in the early postpartum period is indicated, the basic mechanisms, however, are only poorly understood. Psychosocial factors such as social support or quality of marital relation on the other hand may have an impact on the further course of illness.