Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Br J Psychiatry. 2011 Apr;198(4):264-8. doi: 10.1192/bjp.bp.110.082990. Epub 2011 Feb 22.
Postpartum psychosis is a life-threatening psychiatric emergency, which often occurs without significant premorbid symptoms. Although many studies have postulated an involvement of the immune and endocrine systems in the onset of postpartum psychosis, the specific aetiological factors have remained unknown.
To examine the hypothesis that autoimmune thyroid dysfunction may be associated with the onset of postpartum psychosis.
Thirty-one consecutive primiparous women with no prior psychiatric history were referred to our in-patient unit for postpartum psychosis. The control group (n = 117) comprised primiparous women with consecutive deliveries at a community practice. Blood samples were obtained from all participants at 4 weeks and 9 months postpartum. Thyroperoxidase antibody levels were quantified as immunological measures of autoimmune thyroid disease (AITD). Thyroid-stimulating hormone and free thyroxine levels were measured to assess clinical thyroid dysfunction.
At 4 weeks postpartum and prior to the initiation of mood stabiliser therapy, 19% of women with postpartum psychosis had AITD compared with only 5% in the control group. Women with both postpartum psychosis and AITD had a dramatically higher risk of progression to clinical thyroid dysfunction (67%) than control participants with AITD (20%).
Women with postpartum psychosis are at higher risk not only of AITD but also of clinical thyroid failure. These data implicate thyroid function as an important clinical outcome in patients with postpartum psychosis. Further, AITD represents a potentially strong aetiological factor for the development of postpartum psychosis. Therefore, screening for thyroperoxidase antibodies is warranted in patients with postpartum psychosis.
产后精神病是一种危及生命的精神急症，通常在没有明显前驱症状的情况下发生。尽管许多研究假设免疫和内分泌系统的参与与产后精神病的发病有关，但具体的病因因素仍不清楚。
检验自身免疫性甲状腺功能障碍可能与产后精神病发病有关的假说。
31 例连续初产妇因产后精神病被转诊至我们的住院病房。对照组（n=117）由社区实践中连续分娩的初产妇组成。所有参与者在产后 4 周和 9 个月时采集血样。甲状腺过氧化物酶抗体水平被量化为自身免疫性甲状腺疾病（AITD）的免疫测量指标。测量促甲状腺激素和游离甲状腺素水平以评估临床甲状腺功能障碍。
在产后 4 周且在开始使用情绪稳定剂治疗之前，19%的产后精神病妇女患有 AITD，而对照组仅有 5%。患有产后精神病和 AITD 的妇女进展为临床甲状腺功能障碍的风险（67%）明显高于对照组中患有 AITD 的妇女（20%）。
患有产后精神病的妇女不仅患有 AITD 的风险更高，而且患有临床甲状腺功能衰竭的风险也更高。这些数据表明甲状腺功能是产后精神病患者的一个重要临床结局。此外，AITD 代表产后精神病发展的一个潜在强病因因素。因此，对产后精神病患者进行甲状腺过氧化物酶抗体筛查是有必要的。
