Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania; and.
Psychiatry and Neurology Hospital, Brasov, Romania.
Am J Ther. 2020 Jun 22;28(3):e341-e348. doi: 10.1097/MJT.0000000000001218.
Psychotic episodes in the postpartum period are life-threatening psychiatric emergencies, requiring urgent medical attention and admission to a psychiatric hospital.
Although the postpartum psychosis (PPP) is the most severe psychiatric disorder associated with parturition, there is little information about what interventions are most effective. Because there are no specific guidelines for the treatment of PPP, the aim of the present review was to examine the available evidence regarding the treatment of PPP.
The PubMed database was searched based on the title and the abstract, using the key words "postpartum psychosis," "postpartum psychosis antipsychotics," "postpartum psychosis treatment," and "postpartum psychosis pharmacotherapy," for both interventional and observational, irrespective of language.
A number of 14 publications met the study criteria, including case reports and case series. The antipsychotics (APs) use included both first generation APs, such as haloperidol and chlorpromazine, and second generation APs, mainly, olanzapine, quetiapine, and risperidone. The most frequently used AP was olanzapine. Olanzapine and quetiapine seem to be the most acceptable during breastfeeding. Proposed treatment algorithms for the successful management of PPP are discussed.
The existing studies to date do not allow to draw a definitive conclusion regarding which treatment is the most effective or the most adequate. Existing evidence suggests that APs alone or in combination are responsible for sustained remission and that treated PPP has a higher pace of improvement of the mental status, with a rapid discharge from the hospital. Clinical studies to compare the efficacy and safety of different APs in the PPP are needed to provide guidance on treatment interventions.
产后精神病发作是危及生命的精神急症，需要紧急医疗关注并入院接受精神科治疗。
尽管产后精神病（PPP）是与分娩相关的最严重的精神障碍，但关于哪些干预措施最有效的信息很少。由于没有针对 PPP 治疗的具体指南，因此本综述的目的是检查关于 PPP 治疗的现有证据。
根据标题和摘要，在 PubMed 数据库中使用了“产后精神病”、“产后精神病抗精神病药”、“产后精神病治疗”和“产后精神病药物治疗”等关键词，进行了干预和观察性研究，无论语言如何。
有 14 篇符合研究标准的出版物，包括病例报告和病例系列。使用的抗精神病药（APs）包括第一代 APs，如氟哌啶醇和氯丙嗪，以及第二代 APs，主要是奥氮平、喹硫平和利培酮。最常使用的 AP 是奥氮平。奥氮平和喹硫平在母乳喂养期间似乎更能被接受。讨论了用于成功管理 PPP 的拟议治疗算法。
迄今为止的现有研究尚不能得出关于哪种治疗最有效或最合适的明确结论。现有证据表明，APs 单独或联合使用可确保持续缓解，并且经过治疗的 PPP 精神状态改善更快，出院更快。需要进行比较不同 APs 在 PPP 中的疗效和安全性的临床研究，以提供治疗干预的指导。
