POSTPARTUM PSYCHOSIS AND POSTPARTUM THYROIDITIS

The term postpartum psychosis refers to a group of severe and heteroge neous 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 sympto ms was chronologically related to the onset of postpartum thyroiditis and resolution of psychosis synchronized with the achievement of bioch emical euthyroidism. The patient had typical symptoms of 'classic post partum psychosis' (a historical term not included in DSM-IV, but used frequently by many physicians to describe diagnostic and therapeutic c hallenges 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 'preg nancy' and harm to her 'unborn' child. She also believed that her chil d (Jesus) was going to be killed. Other key symptoms included hallucin ations, mixed mood symptoms, agitation and transient disorientation. H er DSM-IV diagnosis on admission was major depression with psychotic f eatures and her discharge diagnosis (most likely diagnosis) was psycho tic disorder due to thyrotoxicosis caused by postpartum thyroiditis. T he differential diagnosis of co-occurring psychosis and postpartum thy roiditis can be examined relative to four possibilities: (1) psychosis due to thyrotoxicosis caused by postpartum thyroiditis; (2) a coincid ence (no association between psychosis and postpartum thyroiditis); (3 ) precipitation of psychotic symptoms and disorientation related to po stpartum 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 indication s for thyroid screening in postpartum psychoses. Further research is n eeded to clarify the nosology and mechanisms of severe postpartum diso rders and to elucidate treatment-relevant and etiologically-distinct s ubsets of postpartum psychosis. (C) 1998 Elsevier Science Ltd. All rig hts reserved.