Bokhari R, Bhatara V S, Bandettini F, McMillin J M
Department of Psychiatry, University of South Dakota School of Medicine, Sioux Falls 57104, USA.
Psychoneuroendocrinology. 1998 Aug;23(6):643-50. doi: 10.1016/s0306-4530(98)00034-1.
The term postpartum psychosis refers to a group of severe and heterogeneous disorders with psychotic symptoms that occur most frequently in the context of a mood disorder during the postpartum period. We report a case of 'postpartum psychosis' possibly associated with postpartum thyroiditis in a 29 year-old woman. The appearance of psychotic symptoms was chronologically related to the onset of postpartum thyroiditis and resolution of psychosis synchronized with the achievement of biochemical euthyroidism. The patient had typical symptoms of 'classic postpartum psychosis' (a historical term not included in DSM-IV, but used frequently by many physicians to describe diagnostic and therapeutic challenges posed by puerperal psychoses). Three months postpartum, the patient began to believe that she was pregnant with the Christ child, although she was not pregnant. Her delusions resolved around the 'pregnancy' and harm to her 'unborn' child. She also believed that her child (Jesus) was going to be killed. Other key symptoms included hallucinations, mixed mood symptoms, agitation and transient disorientation. Her DSM-IV diagnosis on admission was major depression with psychotic features and her discharge diagnosis (most likely diagnosis) was psychotic disorder due to thyrotoxicosis caused by postpartum thyroiditis. The differential diagnosis of co-occurring psychosis and postpartum thyroiditis can be examined relative to four possibilities: (1) psychosis due to thyrotoxicosis caused by postpartum thyroiditis; (2) a coincidence (no association between psychosis and postpartum thyroiditis); (3) precipitation of psychotic symptoms and disorientation related to a postpartum thyroiditis in a woman with a pre-existing mood disorder; or (4) both psychosis and thyroiditis caused by a pre-existing defect in autoimmunity. The authors stress the importance of early diagnosis and prompt treatment of postpartum psychosis. They discuss the indications for thyroid screening in postpartum psychoses. Further research is needed to clarify the nosology and mechanisms of severe postpartum disorders and to elucidate treatment-relevant and etiologically-distinct subsets of postpartum psychosis.
产后精神病这一术语指的是一组严重且异质性的疾病，伴有精神病性症状，这些症状最常出现在产后时期的心境障碍背景下。我们报告一例29岁女性可能与产后甲状腺炎相关的“产后精神病”病例。精神病性症状的出现与产后甲状腺炎的发作在时间上相关，且精神病的缓解与生化甲状腺功能正常的实现同步。该患者有“典型产后精神病”的典型症状（这是一个未被《精神疾病诊断与统计手册》第四版收录的历史术语，但许多医生经常使用它来描述产褥期精神病带来的诊断和治疗挑战）。产后三个月，患者开始坚信自己怀有基督之子，尽管她并未怀孕。她的妄想围绕着这个“怀孕”以及对她“未出生”孩子的伤害而展开。她还认为自己的孩子（耶稣）会被杀害。其他关键症状包括幻觉、混合性心境症状、激越和短暂的定向障碍。她入院时的《精神疾病诊断与统计手册》第四版诊断为伴有精神病性特征的重度抑郁，出院诊断（最可能的诊断）是产后甲状腺炎所致甲状腺毒症引起的精神病性障碍。对于同时出现的精神病和产后甲状腺炎的鉴别诊断可参照四种可能性进行考量：（1）产后甲状腺炎所致甲状腺毒症引起的精神病；（2）巧合（精神病与产后甲状腺炎之间无关联）；（3）在已有心境障碍的女性中，产后甲状腺炎引发精神病性症状和定向障碍；或者（4）自身免疫性预先存在缺陷导致精神病和甲状腺炎。作者强调早期诊断和及时治疗产后精神病的重要性。他们讨论了产后精神病中甲状腺筛查的指征。需要进一步研究以阐明严重产后疾病的分类学和机制，并阐明与治疗相关且病因不同的产后精神病亚组。
