Chapter 12 - Hormonal and immunological factors in postpartum psychosis

Abstract

Postpartum psychosis is a rare but disabling disorder with potentially devastating consequences including an increased risk for suicide and infanticide. Postpartum psychosis is characterized by a rapid onset of symptoms including delusions, hallucinations, and paranoia, and occurs in approximately 1–5 in every 1000 births. Interestingly, the incidence of psychosis is greater during the peripartum period than any other time in a woman's life, suggesting vulnerability to psychosis conferred during the peripartum period. Thus, the hormonal changes associated with the peripartum period have been a major focus of investigations into the pathological mechanisms of postpartum psychosis. In addition to the hormonal changes during this time, the peripartum period is also characterized by profound changes in immune function. Although the underlying neurobiology of postpartum psychosis remains unclear, there is evidence for both hormonal and immunological changes which may precipitate postpartum depression and/or contribute to the underlying neuropathology of postpartum psychosis. This review will summarize what is known about the hormonal and immunological changes associated with postpartum psychosis. Given the limited information on postpartum psychosis, this chapter will also discuss hormonal and immunological factors associated with peripartum mood disorders more broadly, including postpartum depression, as well as evidence for involvement in psychosis, particularly focusing on schizophrenia. This chapter will primarily focus on clinical findings, summarizing the current knowledge in the field regarding the hormonal and immunological changes associated with postpartum psychosis and highlighting potential biomarkers. This chapter provides an up-to-date, comprehensive resource summarizing the hormonal and immunological changes associated with postpartum psychosis.