Een acuut beeld dat doortastend optreden vergt
Klinische les
Iris E. Sommer, Metten Somers, Marthe Bartel, Elisabeth Vonk, Rob van Ojen en Marjan Kromkamp

Post-partum psychosis: an acute illness requiring resolute action

This supplementary information is presented as submitted by the corresponding author. It has not been copy-edited by NTvG.

During the nigh shift, we saw a young woman aged 34, brought to the hospital after she jumped from the window together with her three months old son.

She was brought in by an ambulance after she had survived the jump with severe foot fractures. Later that evening, we learnt that her son, who was brought to another hospital, had died. In the weeks after giving birth she suffered from sleep disturbances and fluctuating affect. After initial response to benzodiazepines, her sleeplessness returned and she developed affective flattening. At ten weeks after giving birth, her mood swings became severe and she developed psychotic symptoms that lead her to jump. Psychotic symptoms had developed in just three days time and medical action came too late for her. This sad case illustrates that it is of utmost importance to recognize a post-partum psychosis swiftly and start the right treatment instantly.

We here urge clinicians to be alert to psychotic symptoms in the first months of maternity and refer young mothers with these symptoms at once to a closed ward for adequate treatment. Other treatment settings, such as an open ward, or intensive home treatment are insufficient to prevent suicide and infanticide attempts. Although the absolute number of suicides and infanticides is relatively low, this outcome is to be prevented at all costs, even if involuntary constrains are necessary. Pharmacological treatment starts with benzodiazepines to restore sleep, followed by an antipsychotic agent if this treatment fails to improve the symptoms and followed by lithium augmentation when psychosis and affect do not improve after 2 weeks. Treatment generally improves the symptoms swiftly and outcome is usually good.