Essali Adib, Alabed Samer, Guul Aisha, Essali Norah
Psychiatry Centre, Modern Psychiatry Hospital, Damascus, Syrian Arab Republic.
Cochrane Database Syst Rev. 2013 Jun 6;2013(6):CD009991. doi: 10.1002/14651858.CD009991.pub2.
Postnatal psychosis is a worldwide life-threatening condition that affects one to two in every 1000 new mothers. It has an abrupt onset within a month of childbirth. Affected new mothers rapidly develop frank psychosis, cognitive impairment, and disorganised behaviours. Factors that increase the risk of postnatal psychosis include primiparous mothers who are single, women who are older, or with a past psychiatric history and family history of affective psychosis, prenatal depression and autoimmune thyroid dysfunction. The risk of a future postnatal recurrence is 25% to 57%. Preventive interventions for postnatal psychosis aim at identifying women with risk factors, early recognition of imminent psychosis through screening, and preventive drug therapy. Mood stabilisers, antipsychotic drugs and hormone therapy may be beneficial in the prevention of postnatal psychotic episodes in women at risk.
To investigate the best available evidence for interventions aimed at preventing postnatal psychosis.
We searched the Cochrane Schizophrenia Group Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2012 using the search strategy of the Cochrane Schizophrenia Group.
All randomised controlled trials relevant to the prevention of postnatal psychosis.
Two review authors inspected all citations to ensure reliable selection. If we had included relevant trials, we planned to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors would have independently extracted data. For homogenous dichotomous data, we planned to calculate the risk ratio (RR), 95% confidence interval (CI), and the number needed to treat to benefit/harm (NNTB/NNTH) on an intention-to-treat basis.
There are no included studies in this review. The electronic search produced three relevant references, among which we identified two old planned trials that seem never to have started, and one which we excluded a study because it was a report of a case series.
AUTHORS' CONCLUSIONS: This is not an empty review - it is a review full of unanswered questions. Despite growing interest in women's mental health, the literature in the area of postnatal psychosis is still very limited. It seems that clinicians have no choice but to continue with their current practices guided solely by varied clinical judgement. Women at risk of postnatal psychosis and their relatives are justified to be disappointed in the medical/research fraternity. A post hoc PubMed topic (not methodology-specific) search identified mainly case series. Policy makers have no trial-based evidence upon which to base their guidelines. Certainly, preventive interventions for postnatal psychosis are difficult to justify with confidence without well-designed, well-conducted, and well-reported randomised studies. Available publications suggest that such studies are possible and funders of research may wish to make this work a priority.
产后精神病是一种危及全球产妇生命的疾病，每1000名初产妇中有1至2人受其影响。该病在分娩后一个月内突然发作。患病的初产妇会迅速发展为明显的精神病、认知障碍和行为紊乱。增加产后精神病风险的因素包括单身初产妇、年龄较大的女性、有既往精神病史或情感性精神病家族史的女性、产前抑郁以及自身免疫性甲状腺功能障碍。未来产后复发的风险为25%至57%。产后精神病的预防性干预旨在识别有风险因素的女性，通过筛查尽早识别即将发生的精神病，并进行预防性药物治疗。情绪稳定剂、抗精神病药物和激素疗法可能有助于预防有风险女性的产后精神病发作。
调查旨在预防产后精神病的干预措施的最佳现有证据。
我们于2012年10月使用Cochrane精神分裂症研究组的检索策略，检索了Cochrane精神分裂症研究组试验注册库和Cochrane对照试验中央注册库（CENTRAL）。
所有与预防产后精神病相关的随机对照试验。
两位综述作者检查了所有文献引用，以确保选择可靠。如果我们纳入了相关试验，计划使用《Cochrane干预措施系统评价手册》推荐的标准评估所识别试验的方法学质量。两位综述作者将独立提取数据。对于同质二分数据，我们计划在意向性分析的基础上计算风险比（RR）、95%置信区间（CI）以及治疗获益/伤害所需人数（NNTB/NNTH）。
本综述未纳入任何研究。电子检索产生了三篇相关参考文献，其中我们识别出两项似乎从未开始的旧计划试验，以及一项我们排除的研究，因为它是一个病例系列报告。
这并非一篇空洞的综述——它充满了未解答的问题。尽管对女性心理健康的关注度不断提高，但产后精神病领域的文献仍然非常有限。看来临床医生别无选择，只能继续仅依据不同的临床判断来开展当前的治疗。有产后精神病风险的女性及其亲属有理由对医学/研究界感到失望。一项事后的PubMed主题（非特定方法学）检索主要识别出病例系列。政策制定者没有基于试验的证据来制定他们的指南。当然，在没有设计良好、实施良好且报告充分的随机研究的情况下，很难有信心地证明产后精神病的预防性干预是合理的。现有出版物表明这样的研究是可行的，研究资助者可能希望将这项工作作为优先事项。
