Polish Psychiatric Association Research Articles

Expert opinion of the Heart Failure Association of the Polish Cardiac Society and the Polish Psychiatric Association on the management of patients with heart failure and selected mental disorders (depression, anxiety disorders, sleep disorders, delirium).

Expert opinion of the Heart Failure Association of the Polish Cardiac Society and the Polish Psychiatric Association on the management of patients with heart failure and selected mental disorders (depression, anxiety disorders, sleep disorders, delirium).

The neglected object: A history of the concept of dreams in Polish psychiatry and psychology in the interwar period, 1918-1939.

The development of the concept of dreams in interwar Polish psychiatry and psychology was influenced by Western European concepts as well as by sociocultural factors of the newly independent state. Few Polish psychiatrists addressed the subject of dreams. They were influenced mainly by Sigmund Freud's psychoanalytic concept of dreams, but also by Alferd Adler's, Carl Gustav Jung's, and Wilhelm Stekel's ideas. Nevertheless, they approached psychoanalysis critically. The most comprehensive concept of dreams in Polish psychiatry was oneiroanalysis by Tadeusz Bilikiewicz. Oneironalysis was a method of dream analysis based on psychoanalysis but it rejected the psychoanalytic method of free associations and challenged psychoanalytic approaches to the interpretation of dream symbols. Polish psychologists were even less interested in dreams than psychiatrists. Problems with dreams, the most elaborate psychological work by Stefan Szuman consisted of an outline of epistemological problems with general theories of dreams and a harsh critique of psychoanalysis. The neglect of the subject of dreams in Polish psychiatric society can be seen as connected with the social and professional reception of psychoanalysis in Poland. Psychoanalysis was met with opposition from conservative scholars and publicists presenting nationalistic and anti-Semitic attitudes. It was also criticized by the biologically oriented majority of psychiatrists of the Polish Psychiatric Association. In the case of psychology, the most influential Polish psychological school, Lvov-Warsaw School, promoted Brentanian intentionalism, introspection, and psychology of consciousness, therefore, leading to psychologists' reluctance to explore unconscious states like dreams.

Management of nicotine dependence in patients with psychiatric disorders - recommendations of the Polish Psychiatric Association - part I.

Smoking and nicotine dependence are still one of the main reasons for a number of serious and life-shortening somatic diseases. At the same time, they are more prevalent in mentally ill individuals than in the general population. This work, which constitutes the first part of recommendations of the Polish Psychiatric Association, presents the scale of the phenomenon in the general population and among people with psychiatric disorders, diagnostic criteria of nicotine dependence and nicotine withdrawal. It discusses the impact of smoking and exposure to cigarette smoke on the development and course of psychiatric disorders as well as on the treatment of psychiatric disorders, including interactions between nicotine and psychotropic medications. Many psychiatric patients can reduce smoking or achieve complete abstinence if they are offered adequate motivation and therapeutic support. Contrary to popular belief, smoking cessation and nicotine dependence treatment do not negatively affect the symptoms of psychiatric disorders; patients' mental conditions can improve following smoking cessation therapy. The best results in terms of maintaining abstinence are achieved with a treatment approach that combines pharmacotherapy with psychotherapeutic intervention integrated into routine psychiatric care.

Management of nicotine dependence in patients with psychiatric disorders - recommendations of the Polish Psychiatric Association - part II.

The development of treatment methods for nicotine dependence has progressed slowly because people with psychiatric disorders are usually excluded from participating in clinical trials. There are several therapeutic options to support smoking cessation, including psychological and pharmacological interventions, which should be offered to smokers with mental disorders. The first step in helping tobacco smokers and nicotine-dependent individuals is the assessment of smoking intensity and confirmation of nicotine dependence. Currently, we have several methods of treating nicotine dependence - starting from education and psychotherapy, through pharmacotherapy and replacement therapy, and ending up with obtaining gradual progress with the application of harm reduction. Pharmacological treatment options include nicotine replacement therapy, varenicline or bupropion. The effectiveness of such interventions can be improved by providing anti-smoking therapy under psychiatric treatment and promoting harm reduction as an acceptable initial therapeutic goal. The harm reduction strategy is an approach that should be taken into account individually, particularly in the case of individuals unable to stop smoking, patients with limited insight into their illness, patients experiencing an exacerbation of their illness and persistently uncooperative patients. In this paper, recommendations of the Polish Psychiatric Association on the diagnostics and different treatment methods for nicotine dependence in patients with psychiatric disorders are presented.

Obesity in Adults: Position Statement of Polish Association for the Study on Obesity, Polish Association of Endocrinology, Polish Association of Cardiodiabetology, Polish Psychiatric Association, Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons, and the College of Family Physicians in Poland.

Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.

You are not alone…Polish Psychiatric Association supporting Ukraine

AbstractImmediately after Russia commenced aggression against Ukraine, the Polish Psychiatric Association publicly called for humanitarian support for Ukraine and initiated meetings with representatives of Psychiatric Societies operating in Ukraine in order to identify current needs in the war-stricken areas and coordinate aid.The PPA allocated its financial resources to humanitarian aid and, through the EPA, appealed for condemnation of military operations as well as support for Ukraine by individual NPAs.According to the UHNR data over 4 million displaced people, refugees, came to Poland so far and some of them benefited from such help.The Polish Psychiatric Association supports the initiatives of non-governmental organizations supporting refugees and monitors and responds to the needs reported by the Ukrainian side on an ongoing basis. At present, the PPA activities focus on the following priorities:1. Need-adapted-help: Provision of customized aid - not only medications but also power generators, technical equipment. And so, the PPA shipped to Ukraine some basic equipment, sleeping mats, bedding, mattresses, backpacks, cleaning products, personal hygiene products, as well as tools for renovation and construction.2. Awareness - highlighting the consequences of Russia’s aggression on people with mental disorders in Ukraine and its impact on the entire population (PTSD, grief ). Inviting and lobbying for dissemination of personal reports of Ukrainian health care workers and patients at international conventions, forums, events3. Empowerment of personnel - strengthening competences required in provision of assistance in war-related disorders, training, projects of activities both across Poland and Ukraine4. Supporting and responding to the needs reported by local psychiatric assistance centers facilitating and strengthening the competence of personnel in helping refugeesDisclosure of InterestNone Declared

Use of psychotropic medications during lactation - practical guidelines for psychiatrists.

Breastfeeding is the best way of feeding infants. It is recommended by national, European and worldwide scientific associations. The advantages of breastfeeding for both the child and the mother have been proven by research. It is widely known that most Polish women start to breastfeed immediately after delivery, however, with each month, the percentage of infants given breast milk exclusively is decreasing. One of the frequent causes of breastfeeding cessation reported by women is the necessity of pharmacotherapy. There are many controversies over the use of psychotropic medications in particular. Nowadays, based on relevant current data, medications pharmacokinetics and applicable pharmacopeia, it is possible to find a therapy that may be both efficient for the mother and safe for the child. In this review, we examine available sources of data on the use of psychotropic medications during lactation. Different groups of psychiatric medications are discussed and rated in terms of their safety during breastfeeding. The Polish Psychiatric Association recommends a course of treatment to support lactation. Both termination of therapy by the mother and interruption of breastfeeding have negative consequences for both the mother and her child. The decision to let the mother continue breastfeeding may be difficult for a psychiatrist. The problem needs to be discussed thoroughly with the patient and should be carefully documented. Cooperation with other specialists such as a pediatrician and/or a lactation consultant is also highly recommended.

Should we despecialize the training? Postgraduate training in psychiatry in the time of the COVID-19 outbreak in poland: Challenges & solutions

IntroductionThe outbreak of the SARS-CoV-2 epidemic forced a change in the functioning of health care systems across the globe, requiring rapid adaptation to new conditions for the safe provision of services within all medical fields. General disruption has also affected the traditional program of a postgraduate training, which has been so far fixed with temporary solutions, but not given a proper evaluation in the times of big expectations and pressures from both patients and healthcare workers.ObjectivesOutbreak of the COVID-19 put psychiatry trainees and Early Career Psychiatrists in an unprecedented position of responsibility for treatment of a variety of comorbidities they had no prior experience with due to closure of specialized hospital departments and limited access to regular diagnostic tools. In addition to changes in clinical practice and deployment to unfamiliar ground, rescheduling of different components of regular training, transferring most of the educational activities to distance learning, limiting professional growth by canceling most courses and conferences only strengthened the feeling of uncertainty caused by constant adjustments of the final examinations’ conditions.MethodsThe Speciality Training Section of the Polish Psychiatric Association decided to review changes forced by the COVID-19 outbreak in a traditional postgraduate training program in psychiatry.ResultsIdentified shortcomings pose questions about the necessity of a solid revision of the training in order to cope with more demanding working conditions.ConclusionsPresented recommendations may be the starting point for a discussion on the programs’ evaluation across the entire region.DisclosureNo significant relationships.

Pharmacological treatment of a depressive episode and recurrent depressive disorder - guidelines of the Polish Psychiatric Association and the National Consultant for Adult Psychiatry.

Under the auspices of the Polish Psychiatric Association and the National Consultant in Psychiatry, on the basis of analysis of international guidelines, the expert group consisting of psychiatrists and an epidemiologist compiled recommendations for the treatment of adepressive episode and recurrent depressive disorder. The recommendations take into account the information that the patient should receive before starting the treatment, the selection criteria for the treatment method and the choice of the antidepressant, the method of assessing the efficacy of treatment, treatment monitoring, and the duration of treatment. Formulating the recommendations, the experts analyzed the source data for their applicability in Poland. The current recommendations of scientific societies and an analysis of the literature on the treatment of depressive episodes and recurrent depressive disorder broken down by the treatment of acute episodes and maintenance treatment, as well as the recommendations on the method of creating guidelines have been taken into account. Furthermore, the guidelines developed in collaboration with the Supreme Medical Council and the Polish Psychiatric Association, entitled: "Diagnostic work-up and treatment of depression in adults - guidelines for family physicians", and recommendations of theNationalConsultantin Adult Psychiatry have been taken into account. The recommendations were discussed among the experts and accepted by the General Board of the Polish Psychiatric Association. Subsequently, the recommendations were modified in line with the Board's commentsand endorsed by the Association for use in the management of patients with depression in Poland.

Treatment of overweight and obesity during and after a pandemic. Let’s not wait for the development of complications — new guidelines for doctors

Guidelines developed by Experts endorsed by the Polish Association for the Study of Obesity, Polish Psychiatric Association, Polish Society of Hypertension, Scientific Section of Telepsychiatry of the Polish Psychiatric Association, Polish Association of Cardiodiabetology, Polish Association of Endocrinology, and The College of Family Physicians in Poland Social patronage of the Foundation for People with Obesity OD-WAGA The treatment of obesity in the pandemic era has become more important than ever. The current situation is conducive to the worsening of disease and the development of new diseases, mainly as a result of compensating negative emotions with food. Taking into account the data on the impact of obesity and its complications on the severity of the course and the risk of death due to COVID-19, we recommend using the 2016 American Endocrine Society’s criteria for the diagnosis of obesity instead of the 1998 WHO criteria. We also recommend diagnosing eating under the influence of emotions and the occurrence of eating disturbances, such as compulsive eating syndrome, night eating syndrome and food addiction, and complications of obesity, in any person with a BMI ≥ 25 kg/m 2 . The approach to treatment should be individualised and should not be limited to nutritional and physical activity education alone. Each patient should be offered appropriately selected pharmacotherapy, and, if necessary, also psychotherapy. The first-line drug should be a combined preparation containing naltrexone and bupropion (Mysimba ® ). Liraglutide in a dose of 3 mg (Saxenda ® ) should be considered as a second-line drug in a situation where eating under the influence of emotions is excluded (reaching for food in situations of experiencing negative and positive emotions and boredom, eating disturbances: compulsive eating syndrome, night eating syndrome, and food addiction) and depressed mood or there are permanent contraindications to the use of the first-line drug. It is unethical not to treat obesity or refer the patient to another doctor for treatment. The use of telemedicine tools can facilitate work in therapeutic teams (doctor, dietitian, psychotherapist), as well as improve patient compliance with pharmacotherapy and changes in eating habits and the level of physical activity recommendations.

Pacjentka z rozpoznaniem zaburzeń depresyjnych — interakcje lekowe oraz postępowanie w przypadku dodatniego wyniku COVID-19

This article presents guidelines for the management of a psychiatric patient infected with COVID-19. The Polish Psychiatric Association provides recommendations and tips, including guidelines from other countries regarding the treatment of psychiatric patients during the epidemic time. In Poland, patients requiring psychiatric hospitalization have been treated in centers appointed by the government. In the West Pomerania region such center is the Department of Psychiatry of Pomeranian Medical University in Szczecin. Psychiatric wards have been transformed and adapted to the profile of infected or potentially infected patients who have been quarantined. We present the case of the patient with an affective disorder who was hospitalized on the local infectious ward, the possible difficulties associated with drug interactions between psychiatric drugs and those used to treat COVID-19 infection.

SARS-CoV-2 pandemic and the population with dementia. Recommendations under the auspices of the Polish Psychiatric Association.

SARS-CoV-2 poses a particular risk to the elderly and people with many comorbidities. In the case of people with dementia, the compliance with sanitary recommendations and the necessary physical isolation can have far-reaching negative consequences in terms of limiting the continuation of tailored care, support and treatment. The recommendations related to the SARS-CoV-2 pandemic must take into account not only the medical consequences of lack of access to medical care, but also their long-term effects and the disease progression in accordance with the concept of social health. A plan of action for the psychoeducation of informal carers, adapted to the elderly group (including people with dementia), is also necessary. Prepared under the auspices of the Polish Psychiatric Association, the recommendations for people living alone, with their family and in long-term care facilities are intended to draw attention to key epidemiological issues that can be planned by medical staff within the organization of patient care. However, mental and social needs of patients, whose fulfilment is particularly significant in times of restrictions related to everyday activities, are of equal importance. Further monitoring of the epidemiological situation and scientific reports related to the SARS-CoV-2 pandemic are necessary to verify and update the guidelines.

Telewizyta (e-wizyta) na czas kryzysu epidemicznego — rekomendacje w zakresie prowadzenia wizyt online w opiece psychiatrycznej

Telepsychiatria obejmuje świadczenie usług leczniczych poprzez nowoczesne media cyfrowe. Leczenie psychiatryczne i psychoterapeutyczne prowadzone online jest skuteczne i bezpieczne oraz ekwiwalentne terapeutycznie w porównaniu z tradycyjnym leczeniem offline. W okresie kryzysu epidemicznego i ograniczenia świadczenia porad ambulatoryjnych telepsychiatria jest metodą alternatywną i zalecaną. W artykule przedstawiono rekomendacje w zakresie prowadzenia wizyt online w opiece psychiatrycznej przygotowane przez Sekcję Naukową Telepsychiatrii Polskiego Towarzystwa Psychiatrycznego. Omówiono formę i tematykę prowadzenia telewizyt, z uwzględnieniem czynników reaktywnych i somatycznych, zaproponowano również schemat telewizyty psychiatrycznej i somatycznej.

From Editors

The year 2020 marks the 100th anniversary of the Polish Psychiatric Association. We would therefore like to begin this issue with a review by D. Palumbo and S. Galderisi- (Past President of the European Psychiatric Association) from Naples, Italy, on “Controversial issues in current definitions of mental health”. The paper focuses on recently proposed mental health definitions, with a particular emphasis on mental health normative criteria involved in each of them. The next paper, “War trauma and self-help” by P. Piotrowski et al., is an attempt to analyze the frontline soldier drawings, inscriptions and the author’s text entitled “In the time of war”, as a form of self-help.

Treatment of overweight and obesity during and after a pandemic. Let’s not wait for the development of complications – new guidelines for doctors

Guidelines developed by Experts endorsed by the Polish Association for the Study of Obesity, Polish Psychiatric Association, Polish Society of Hypertension, Scientific Section of Telepsychiatry of the Polish Psychiatric Association, Polish Association of Cardiodiabetology, Polish Association of Endocrinology, and The College of Family Physicians in Poland Social patronage of the Foundation for People with Obesity OD-WAGA The treatment of obesity in the pandemic era has become more important than ever. The current situation is conducive to the worsening of disease and the development of new diseases, mainly as a result of compensating negative emotions with food. Taking into account the data on the impact of obesity and its complications on the severity of the course and the risk of death due to COVID-19, we recommend using the 2016 American Endocrine Society’s criteria for the diagnosis of obesity instead of the 1998 WHO criteria. We also recommend diagnosing eating under the influence of emotions and the occurrence of eating disturbances, such as compulsive eating syndrome, night eating syndrome and food addiction, and complications of obesity, in any person with a BMI ≥ 25 kg/m 2 . The approach to treatment should be individualised and should not be limited to nutritional and physical activity education alone. Each patient should be offered appropriately selected pharmacotherapy, and, if necessary, also psychotherapy. The first-line drug should be a combined preparation containing naltrexone and bupropion (Mysimba ® ). Liraglutide in a dose of 3 mg (Saxenda ® ) should be considered as a second-line drug in a situation where eating under the influence of emotions is excluded (reaching for food in situations of experiencing negative and positive emotions and boredom, eating disturbances: compulsive eating syndrome, night eating syndrome, and food addiction) and depressed mood or there are permanent contraindications to the use of the first-line drug. It is unethical not to treat obesity or refer the patient to another doctor for treatment. The use of telemedicine tools can facilitate work in therapeutic teams (doctor, dietitian, psychotherapist), as well as improve patient compliance with pharmacotherapy and changes in eating habits and the level of physical activity recommendations.

Redukcja ryzyka metabolicznego u chorych na schizofrenię przyjmujących leki przeciwpsychotyczne – zalecenia Polskiego Towarzystwa Psychiatrycznego

Patients with schizophrenia are susceptible to physical illnesses, which reduces their life expectancy by an average of 20 years compared with the general population. The most common physical illnesses amongst patients with schizophrenia are metabolic disorders and cardiovascular diseases. The aim of this paper is to present recommendations on metabolic risk reduction in patients with schizophrenia treated with antipsychotics, accepted as a position statement of the Polish Psychiatric Association for use in the management of persons suffering from schizophrenia in Poland. A routine assessment of metabolic risk is recommended for the early detection of metabolic disorders and to monitor the safety of the antipsychotic treatment. It includes: medical history, physical examination, laboratory tests. Each patient should undergo this assessment before the initiation of treatment, after 6 and 12 weeks of treatment, and at least once a year thereafter. In men and women suffering from schizophrenia who are over the age of 40 and 50 years, respectively, a cardiovascular risk assessment using the SCORE charts is also recommended. (1) Antipsychotics with a low potential to cause metabolic disorders should be preferred and administered at the appropriate dose in order to reduce metabolic risk. (2) If other agents found to cause metabolic disorders are used, the treatment should be modified by augmentation or by switching to another antipsychotic with a lower potential to cause metabolic disorders. (3) Consultation by an internal medicine specialist and medical treatment should be recommended. (4) Patients should be assisted in developing healthy eating habits, encouraged to pursue regular physical activity and (5) to quit smoking, drinking alcohol and using psychoactive substances.

Recommendations for the treatment of schizophrenia with negative symptoms. Standards of pharmacotherapy by the Polish Psychiatric Association (Polskie Towarzystwo Psychiatryczne), part 1.

Schizophrenia is a chronic illness that in the majority of cases begins either in adolescence or early adulthood. It is often perceived as a severe, incurable condition with generally poor prognosis, while patients suffering from it tend to be agitated, aggressive and unpredictable in their behaviors. Growing awareness, along with gradual changes in the approach to the need for multifaceted schizophrenia therapy, as well as considerable progress in pharmacotherapy in recent years have allowed for improving the prognosis for many patients. Because of polymorphic character of the condition, many schizophrenia sub-types are identified by means of classifications of mental disorders, adjusting the criteria and descriptions to most frequently observed clinical scenarios. Clinical descriptions of schizophrenia are based on various psychopathological models, which are often multidimensional and multifactorial. They virtually always take account of the following two dimensions: negative (deficit) and positive (creative) symptoms. Contemporary approach to schizophrenia treatment assumes multidirectional therapeutic intervention aimed at achieving full remission and the patient's return to full psychosocial functioning. Long-term studies indicate that the severity of negative symptoms is the prognostic indicator of the deterioration of social and professional functioning and reduced quality of life. The following paper presents the review of concepts and research devoted to negative symptoms in schizophrenia and their treatment; in the second part, international standards and recommendations of the Polish Psychiatric Association concerning the approach to effective management of negative symptoms in schizophrenia are discussed.

Recommendations for the treatment of schizophrenia with negative symptoms. Standards of pharmacotherapy by the Polish Psychiatric Association (Polskie Towarzystwo Psychiatryczne), part 2.

Contemporary approach to schizophrenia treatment assumes multidirectional therapeutic intervention aimed at achieving full remission and the patient's return to full psychosocial functioning. Properly selected and administered pharmacotherapy still plays the key role in schizophrenia treatment. In previous decades (starting from the 1950s) the use of antipsychotics aimed mostly at managing positive symptoms (aggression, agitation). In subsequent decades (starting from the 1980s) it was possible to use new generation medications with fewer side effects. Some of those medications turned out to be also helpful in alleviating negative symptoms, which gave some patients an opportunity to return to normal functioning. Nevertheless, there is still a common belief that schizophrenia patients with predominant or persistent negative symptoms are the most serious challenge from the therapeutic perspective. They are characterized by worse course of the illness, poorer prognosis and response to treatment. There is constant need for new, more effective therapeutic interventions. The following paper presents international standards and recommendations of the Polish Psychiatric Association for effective approach to treating negative symptoms in schizophrenia.

Recommendations of the Polish Psychiatric Association for treatment of affective disorders in women of childbearing age. Part III: Approach to pregnancy loss and unsuccessful in vitro treatment of infertility.

This article presents recommendations of the Polish Psychiatric Association regarding approach to pregnancy loss and unsuccessful in vitro treatment of infertility. From the psychological perspective pregnancy loss and perinatal death are amongst the most stressful events in human life - carrying increased risk of developing affective, anxiety or post-traumatic stress disorders. Psychologists, physicians and the rest of the medical staff should provide integrated and individualized care which should be based on respect, empathy and expertise. The necessary phases of support for women experiencing pregnancy loss are: (1) physician providing exhaustive informational support regarding state of health, potential causes of fetal death, further approach and phases of induced labor of the fetus/pregnancy termination/procedure, (2) facilitating psychological consultation at any time and (3) providing exhaustive information on current legal standing (health insurance and labor law). Experiencing recurrent in vitro fertilization failures may result in the emotional consequences similar to those observed in miscarriages. The prolonged frustration may favor developing depressive symptoms and escalate pathological anxiety. We present basic recommendations for psychotherapy and pharmacotherapy in pregnancy loss and unsuccessful in vitro infertility treatment.

Recommendations of the Polish Psychiatric Association regarding the treatment of affective disorders in women of childbearing age. Part II: Bipolar disorder.

In the article, the recommendations of the Polish Psychiatric Association regarding pharmacological treatment of women with bipolar disorder during pregnancy and postpartum period were presented. The issue pertains to every twentieth woman wanting to get pregnant. Before planned pregnancy, it is advisable to obtain a several-month stabilization of psychiatric state, to establish treatment with one mood-stabilizing drug (except for valproate and carbamazepine) or gradual discontinuation of drugs in case of mild course of illness and lack of recurrences in recent two years. In the first trimester of pregnancy, the dose of the mood-stabilizing drug should be reduced (lithium carbonate to 500 mg/day). Depression during pregnancy can be treated with quetiapine or lamotrigine or with antidepressant drug added to a mood-stabilizing drug. Atypical antipsychotics drugs with mood-stabilizing properties can be used in case of (hypo) manic or mixed states. Following the delivery, it is advisable to introduce a moodstabilizing drug as soon as possible to prevent postpartum psychiatric disturbances. In the treatment of postpartum depression, quetiapine can be used or an antidepressant drug added to a mood-stabilizer. Considering breastfeeding, it should be remembered that the infant/maternal ratio of serum drug concentration is low for valproate, olanzapine, quetiapine, sertraline and paroxetine, and high for lithium and lamotrigine. In the case of postpartum psychosis, a hospitalization and antipsychotic treatment are needed.