It is of great regret that although corresponding with him at the start of my research career, I never met Channi Kumar face to face. His work, however, as evidenced by this book, remains an important influence on our field. I share his belief in the ‘maternal brain as a model for investigating mental illness’ (Kumar 2001), and this conviction has underlined much of my research. In this chapter I will discuss the concept of postpartum psychosis (PP), explore what we know about the relationship of these episodes to other mood and psychotic disorders, and consider research strategies aimed at understanding the nature of the postpartum trigger. I will argue that the nosological confusion surrounding this condition has been unhelpful and that it is time, perhaps, to consider whether we should revive postpartum psychosis as a diagnostic concept. Episodes of mood disorder in relation to pregnancy and childbirth are very common. In our group we have recently examined the history of perinatal episodes in over 1,500 women with mood disorder who have participated in our genetic studies and find that approximately two thirds of parous women, with both bipolar and unipolar disorder, have experienced a significant mood episode in the perinatal period (Di Florio et al. 2013). PP refers to some of the most severe forms of postpartum psychiatric disorder. Although the boundaries of this condition are not easy to define, the core concept is the acute onset of a manic or affective psychosis in the immediate postpartum period. Depending on the definition employed, the incidence is approximately 1 in 1,000 deliveries (Jones et al. 2010). Women may go from being very well to severely ill within hours. Affective (mood) symptoms, both elation and depression, are prominent, as is a disturbance of consciousness marked by an apparent confusion, bewilderment, or perplexity. As the name suggests, psychotic phenomena occur, with delusions and hallucinations prominent. Some women with severe manic episodes, but who do not show psychotic symptoms, may receive the diagnosis, although it is also possible to reserve the label for those women with frank psychotic presentations.
Lithium and Renal Impairment: A Review on a Still Hot Topic
