Prophylactic lithium in puerperal psychosis: the experience of three centres

Article Abstract:

In the general population, risk for postpartum (after giving birth) psychosis is approximately 1 in 500. However, for women with a history of bipolar affective disorder or previous psychosis associated with childbirth, the risk is increased to 1 in 5. To evaluate the effect of lithium on preventing puerperal (after giving birth) psychosis, 21 women (average age 23.1 years) from three separate clinics who were at high-risk for developing postpartum psychosis were studied. All but five of the women had family members with a history of mental illness. The women agreed not to become pregnant during the study, and to avoid breastfeeding to prevent lithium toxicity in their infants. In two of the centers, lithium treatment was started within 24 hours after delivery. In one center, lithium administration began in the 34th week of pregnancy and was decreased daily after delivery. Lithium blood levels were monitored frequently and the women were followed-up as out-patients for six months. Nineteen of the women were free of postpartum psychosis during lithium treatment. Three suffered mild and brief episodes of confusion and depression after lithium withdrawal, but were successfully treated with antianxiety drugs. Two women suffered puerperal psychosis while taking lithium. Both of these women were from the center that prescribed lithium during pregnancy, and one had delivered a stillborn baby. In light of the strong familial history of mood disorder, the prevalence of bipolar affective disorder, and past episodes of puerperal psychosis among the women in the study, the recurrence rate of 10 percent was much lower than expected for high-risk women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Postpartum depression, Drug therapy, Lithium, Lithium (Metal), Postpartum psychiatric disorders, Puerperal psychoses

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Brain lesions and cognitive function in late-life psychosis

Article Abstract:

Whether or not true psychosis (e.g., schizophrenia) can develop later in life remains controversial. There have been many studies during this century but the phenomenon remains poorly understood. With more advanced technology, evidence is accumulating that brain disease or structural damage may contribute to, if not cause, what has been called late-life psychosis (LLP). LLP is not considered a form of schizophrenia or other psychiatric illness. It is possible that brain lesions may not have been detected in prior research with less reliable diagnostic techniques. To study the incidence of structural brain damage in those with LLP, psychiatric, neurological, and neuroimaging (e.g. magnetic resonance imaging, or MRI) tests were performed on 24 patients whose first psychotic episode occurred after the age of 45. There were 72 elderly controls as well, who received the same battery of tests. It was found that 42 percent of the subjects with LLP had structural brain abnormalities and 58 percent suffered from neuromedical illness (nerve diseases). Intellectual and memory deficits were common as well. There was nothing in the findings that would have predicted the structural abnormalities found with MRI. It is important that this type of assessment be made on patients who appear to develop psychotic disorders late in life, as some causes of structural brain abnormalities may be reversible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Aged, Elderly, Usage, Diagnosis, Causes of, Complications and side effects, Magnetic resonance imaging, Brain diseases, Psychoses, Psychotic disorders, Psychological manifestations of general diseases, Psychological symptoms

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