Treatment of Psychosis and Mania in the Postpartum Period
Treatment of Psychosis and Mania in the Postpartum Period
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DOI：
10.1176/appi.ajp.2014.13121652
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发表时间：
2015-02-01
影响因子：
17.7
通讯作者：
Kushner, Steven A.
中科院分区：
文献类型：
--
作者：
Bergink, Veerle;Burgerhout, Karin M.;Kushner, Steven A.
产后精神病是一种严重的疾病，需要急性临床干预。然而，人们对哪种干预措施最有效知之甚少。作者介绍了产后9个月的治疗反应和缓解结果，使用四步算法对产后首发精神病或躁狂患者进行治疗。治疗包括苯二氮卓类药物、抗精神病药物、锂离子和电痉挛治疗。对64例连续入院的产后精神病患者的临床缓解情况进行了研究。缓解被定义为至少1周没有精神病性、躁狂和严重抑郁症状。服用抗精神病药物单一疗法缓解的妇女被建议继续这种治疗作为维持治疗，同时需要抗精神病药物和锂药物来达到缓解的妇女继续使用锂药物单一疗法。复发定义为出现任何符合DSM-IV-TR标准的情绪或精神病发作。使用这种治疗算法，作者观察到几乎所有患者（98.4%）在前三个步骤内完全缓解。没有病人需要电痉挛治疗。产后9个月，79.7%的患者持续缓解。接受锂治疗的患者与接受抗精神病单药治疗的患者相比，复发率显著降低。多胎和非情感性精神病被确定为复发的危险因素。作者得出结论，有序添加苯二氮卓类药物、抗精神病药物和锂的结构化治疗算法可能导致首次发作的产后精神病患者的高缓解率，并且锂维持可能最有利于预防复发。
Postpartum psychosis is a severe disorder that warrants acute clinical intervention. Little is known, however, about what interventions are most effective. The authors present treatment response and remission outcomes at 9 months postpartum using a four-step algorithm in patients with first-onset psychosis or mania in the postpartum period. Treatment involved the structured sequential administration of benzodiazepines, antipsychotics, lithium, and ECT. The outcome of clinical remission was examined in 64 women consecutively admitted for postpartum psychosis. Remission was defined as the absence of psychotic, manic, and severe depressive symptoms for at least 1 week. Women who remitted on antipsychotic monotherapy were advised to continue this treatment as maintenance therapy, and women who required both antipsychotics and lithium to achieve remission were maintained on lithium monotherapy. Relapse was defined as the occurrence of any mood or psychotic episode fulfilling DSM-IV-TR criteria. Using this treatment algorithm, the authors observed that nearly all patients (98.4%) achieved complete remission within the first three steps. None of the patients required ECT. At 9 months postpartum, Sustained remission was observed in 79.7%. Patients treated with lithium had a significantly lower rate of relapse compared with those treated with anti psychotic monotherapy. Multiparity and nonaffective psychosis were identified as risk factors for relapse. The authors conclude that a structured treatment algorithm with the sequential addition of benzodiazepines, antipsychotics, and lithium may result in high rates of remission in patients with first-onset postpartum psychosis and that lithium maintenance may be most beneficial for relapse prevention.