Elsevier

Psychoneuroendocrinology

Volume 23, Issue 6, August 1998, Pages 643-650
Psychoneuroendocrinology

POSTPARTUM PSYCHOSIS AND POSTPARTUM THYROIDITIS1

https://doi.org/10.1016/S0306-4530(98)00034-1Get rights and content

Abstract

The term postpartum psychosis refers to a group of severe and heterogeneous disorders with psychotic symptoms that occur most frequently in the context of a mood disorder during the postpartum period. We report a case of ‘postpartum psychosis’ possibly associated with postpartum thyroiditis in a 29 year-old woman. The appearance of psychotic symptoms was chronologically related to the onset of postpartum thyroiditis and resolution of psychosis synchronized with the achievement of biochemical euthyroidism. The patient had typical symptoms of ‘classic postpartum psychosis’ (a historical term not included in DSM-IV, but used frequently by many physicians to describe diagnostic and therapeutic challenges posed by puerperal psychoses). Three months postpartum, the patient began to believe that she was pregnant with the Christ child, although she was not pregnant. Her delusions revolved around the ‘pregnancy’ and harm to her ‘unborn’ child. She also believed that her child (Jesus) was going to be killed. Other key symptoms included hallucinations, mixed mood symptoms, agitation and transient disorientation. Her DSM-IV diagnosis on admission was major depression with psychotic features and her discharge diagnosis (most likely diagnosis) was psychotic disorder due to thyrotoxicosis caused by postpartum thyroiditis. The differential diagnosis of co-occurring psychosis and postpartum thyroiditis can be examined relative to four possibilities: (1) psychosis due to thyrotoxicosis caused by postpartum thyroiditis; (2) a coincidence (no association between psychosis and postpartum thyroiditis); (3) precipitation of psychotic symptoms and disorientation related to postpartum thyroiditis in a woman with a pre-existing mood disorder; or (4) both psychosis and thyroiditis caused by a pre-existing defect in autoimmunity. The authors stress the importance of early diagnosis and prompt treatment of postpartum psychosis. They discuss the indications for thyroid screening in postpartum psychoses. Further research is needed to clarify the nosology and mechanisms of severe postpartum disorders and to elucidate treatment-relevant and etiologically-distinct subsets of postpartum psychosis. © 1998 Elsevier Science Ltd. All rights reserved.

Section snippets

INTRODUCTION

The uniqueness of postpartum psychiatric disorders has been recognized for centuries (Parry, 1995). Following pregnancy, women have almost a 4-fold increase in chance of being hospitalized with a psychotic disorder within 2 years after childbirth. The risk is highest in primiparas and in the first 3 months following pregnancy (Kendell et al., 1987). One of the earliest descriptions of postpartum psychosis was by Victor Marce’ who in 1858 observed these disorders (‘sympathie morbide’) to have

CASE REPORT

A 29-year-old, gravida 3, para 3, woman was hospitalized 3 months postpartum because of agitation, delusions, and hallucinations. About 2 weeks prior to admission, she started to experience severe insomnia, weight loss, fatigue and heat intolerance. At this point, she began to have visual and auditory hallucinations and appeared confused to her husband. She was not able to take care of herself or her infant. She developed extreme religiosity and believed that she was pregnant with the Christ

DISCUSSION

The patient exhibited typical symptoms for PPT and postpartum psychosis, although she did not meet DSM-IV criteria for postpartum onset (DSM-IV allows the specifier ‘with postpartum’ onset to be used in cases of mood disorders when the onset is within 4 weeks postpartum) (American Psychiatric Association, 1994, Gitlin and Pasnau, 1989, Inwood, 1985, Kendell et al., 1987, Parry, 1995, Pritchard and Harris, 1996). The physical examination (goiter, brisk reflexes, and tachycardia) and laboratory

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    1

    Presented at the 27th congress of International Society of Psychoneuroendocrinology (August 1996), Cascais, Portugal.

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