Postpartum Psychosis: Four Step Algorithm

Postpartum psychosis is a severe disorder that requires acute clinical intervention.

Bergink et al published the following four step algorithm for postpartum psychosis management:

 


STEP 1:

Benzodiazepines for 3 days (to improve sleep).

IF NO REMISSION ==> Go to Step 2

Note: Remission is defined as the absence of psychotic, manic, and severe depressive symptoms for at least 1 week. 

 


STEP 2:

Combination of benzodiazepine and antipsychotics for 2 weeks.

IF REMISSION –>  

  • Taper Benzodiazepines.

  • Continue antipsychotics for 9 months postpartum. 

IF NO REMISSION ==> Go to Step 3

 


STEP 3:

Combination of benzodiazepine, antipsychotics and Lithium for 12 weeks.

IF REMISSION –>  

  • Taper Benzodiazepines and antipsychotics.

  • Continue Lithium for 9 months postpartum. 

IF NO REMISSION ==> Go to Step 4

 


STEP 4:

Electroconvulsive Therapy

 


IMPORTANT RESULTS FROM THIS STUDY:

 

Using this treatment algorithm

  • Nearly all patients (98.4%) achieved complete remission within the first three steps.

  • None of the patients required ECT. 

  • ~80% with sustained remission at 9 months postpartum.

  • Patients treated with lithium had a significantly lower rate of relapse compared with those treated with antipsychotic monotherapy. 

 


Source: Am J Psychiatry. 2015 Feb 1;172(2):115-23.


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Dr. Harvinder Singh, M.D. (Admin)


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