Similarities and differences between postpartum psychosis and schizophrenia-spectrum psychoses

Postpartalna psihoza je rijetka bolest koja se javlja u postporođajnom razdoblju. Neprepoznata i neliječena može dovesti do neželjenih posljedica poput suicida, agresivnog ponašanja majke prema djetetu pa čak i čedomorstva. Cilj rada je istražiti rizične čimbenike, liječenje i razlike postpartalne psihoze i psihoza spektra shizofrenije. U pregledni članak uključeni su članci koju su pronađeni na PubMed-u uz ključne riječi ("postpartum psychosis" AND (etiology OR epidemiology OR risk factors OR treatment OR lactation OR cause OR clinical presentation OR psychosocial treatment OR psychosis)) s ograničenjem da su publicirani između 2007. i 2017. godine. Ukupno je uključeno 63 članka, od toga 10 prikaza slučajeva, 4 serije slučajeva, 17 preglednih radova, 2 meta analize i 30 izvornih znanstvenih članaka. Iz članaka proizlazi da su najznačajniji rizični čimbenici pozitivna obiteljska anamneza na afektivne psihoze i postpartalnu psihozu, prethodne psihijatrijske bolesti, posebice bipolarni poremećaj i postpartalna psihoza, primiparitet te nedostatak sna neposredno prije i poslije poroda. Liječenje se sastoji od primjene farmakoloških pripravaka, elektrokonvulzivne terapije, psihoterapije te psihosocijalnih intervencija, a ono što pritom treba uzeti u obzir je dojenje, ostvarivanje majčinstva i razvoj odnosa majke i djeteta te uključivanje oca i cijele obitelji s ciljem što bržeg povratka funkcionalnosti obitelji. Glavne razlike u odnosu na shizofreniju su što kod postpartalne psihoze postoji poznati povod za razvoj, manji je utjecaj psiholoških i socioekonomskih čimbenika u razvoju bolesti, povećan rizik nose prethodna postpartalna psihoza i bipolarni poremećaj, a bolest je kraćeg trajanja najčešće s potpunim oporavkom dok se u liječenju moraju uzeti u obzir ginekološke promjene vezane za razdoblje babinja, dojenje te zdravlje novorođenčeta.Postpartum psychosis is a rare disease that occurs during the postpartum period. If unrecognized and untreated, it can lead to undesirable consequences such as suicide, aggressive maternal behavior and even infanticide. The aim of this paper is to investigate risk factors, treatment and differences between postpartum psychosis and schizophrenia-spectrum psychoses. This survey article includes articles found in PubMed with keywords ("postpartum psychosis" AND (etiology OR epidemiology OR risk factors OR treatment OR lactation OR cause OR clinical presentation OR psychosocial treatment OR psychosis)) with a restriction that they were published between 2007 and 2017. Overall, there are 63 articles, including 10 case reports, 4 case series, 17 review papers, 2 meta analyses and 30 original scientific articles. From the articles it follows that the most significant risk factors are a positive family history of affective psychosis and postpartum psychosis, previous psychiatric disorders, especially bipolar disorder and postpartum psychosis, primiparity and lack of sleep just before and after delivery. The treatment consists of the use of pharmacological preparations, electroconvulsive therapy, psychotherapy and psychosocial interventions, with special emphasis on breastfeeding, motherhood and the development of mother and child relationship, but also on the inclusion of the father and the whole family with the aim of recreating family functionality. The cause for postpartum psychosis, unlike schizophrenia, is known, psychological and socioeconomic factors do not affect the development of the disease as much, it does not last as long and most of the patients manage to fully recover. Women who have previously suffered from postpartum psychosis and bipolar disorder have a greater chance of developing the disease, while the course of treatment should take into consideration the changes in the reproductive system related to the postnatal period, breastfeeding and the newborn's health