Strategies to help prevent infanticide, suicide in postpartum psychosis

For the prevention of infanticide and suicide in the postpartum period, experts wrote that inpatient care — preferably at a mother-infant unit — is vital to guarantee safety, complete the diagnostic evaluation and initiate treatment.

In a JAMA Psychiatry viewpoint, Veerle Bergink, MD, PhD, from the department of psychiatry, Icahn School of Medicine at Mount Sinai, and colleagues discussed the importance of identifying and managing women with postpartum psychosis.

“Importantly, infanticide in women with acute postpartum psychosis (PP) can be prevented, because the disorder carries an excellent prognosis when treated in a timely and adequate fashion,” Bergink and colleagues wrote.

Postpartum psychosis refers to women with acute and severe episodes postpartum, not to women with chronic psychotic conditions before and during pregnancy and postpartum. The researchers focused on three types of prevention for women with acute postpartum psychosis:

• primary prevention (for women at high risk);
• secondary prevention (early detection in women without psychiatric history); and
• tertiary prevention (prompt treatment and management to ensure the safety of both mother and child).

For primary prevention, Bergink and colleagues recommended that women with a history of bipolar disorder and/or postpartum psychosis should receive specialist care during pregnancy, see a psychiatrist and have a prebirth planning meeting during pregnancy with their family, friends, mental health professional, etc. to create a postpartum psychosis prevention plan. They advised that this plan include getting enough sleep once the mother gives birth and pharmacologic treatment (ie, lithium and antipsychotic agents) immediately after delivery.

Most women are admitted to hospitals with a diagnosis of postpartum psychosis without a history of psychiatric illness, making early detection key, according to the researchers.

“In clinical practice, it can be challenging to properly discern symptoms more likely to be associated with PP than postpartum depression or physiologic postpartum mood instability,” Bergink and colleagues wrote.

Therefore, for secondary prevention, they recommended conducting an extensive interview of the romantic partner and/or other family members in the diagnostic and risk assessment.

For tertiary prevention, the researchers advised that when the referring physician suspects a possible postpartum psychosis diagnosis, they contact a psychiatrist during the patient consultation and have them evaluated same day. Ideally, the patient will be admitted to inpatient care when the psychiatrist diagnoses postpartum psychosis.

“Pivotal in the adequate management of PP and prevention of suicide and filicide is an adequate infrastructure allowing for fast and efficient communication between the referring physician and psychiatrist, as well as sufficient admission capacity in the area and timely transit to PP treatment facilities,” Bergink and colleagues wrote. “The establishment of psychiatric inpatient mother-infant units in the United States and other nations will save lives of both mothers and infants.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.