Managing Postpartum Psychosis: The Perspective of Perinatal Psychiatry Access Programs

Abstract: While postpartum psychosis occurs in less 1% in the perinatal population, it carries a 5% risk of suicide and infanticide. Most ( >70%) of postpartum psychosis occurs in the context of bipolar disorder. Given the rapid clinical deterioration that occurs with postpartum psychosis, it needs to be diagnosed as early as possible. Perinatal Psychiatry Access Programs (hereafter Access Programs) are statewide or regional population-based models, spanning 29 states in the US. Access Programs support obstetric clinicians in addressing psychiatric illness, including bipolar disorder and postpartum psychosis, through training and consultation. CL psychiatrists at Access Programs are in a unique position to help obstetric clinicians across their state to detect and address bipolar disorder and postpartum psychosis. For example, they may be able to help obstetric clinicians address bipolar disorder and in doing so prevent deterioration to psychosis. In this interactive session, we will use clinical case examples to discuss how CL psychiatrists can assess the risk factors, clinical features and differential diagnoses of postpartum psychosis. We will highlight how to 1) use proactive monitoring and management to prevent postpartum psychosis from occurring 2) how to manage postpartum psychosis when it occurs, and 3) how to adopt an integrative approach to managing postpartum psychosis within population-based models across the country.

Clinical cases will include:
1) A perinatal individual at 4 weeks postpartum with a history of Obsessive Compulsive Disorder and in an unstable housing situation presents with severe anxiety and intrusive thoughts that have significantly worsened since giving birth.
2) A 35 week perinatal individual presents with auditory hallucinations in the context of poor sleep from increased urination and physical discomfort due to pregnancy.
3) A 2 week postpartum perinatal individual who is exclusively breastfeeding becomes non-adherent to Lithium and the obstetric clinician asks the access program to find the patient a psychiatric prescriber because she does not feel comfortable prescribing Lithium.
4) A 1 week postpartum perinatal individual with a history of bipolar disorder, limited psychosocial support, anxiously calls an obstetrician clinician asking for a sleep aid because of poor sleep since delivery.

Dr. Haider, a CL perinatal psychiatrist, will provide a 20-minute introduction to postpartum psychosis and moderate the 45-minute clinical case discussions. The first 20 minutes will discuss postpartum psychosis and how CL perinatal psychiatrists within Access Programs approach postpartum psychosis consultations with calling providers. For the 45 minute interactive clinical case discussion, Drs. Wichman, Wakefield and Byatt, CL perinatal psychiatrists, will present and discuss the above most common case scenarios that Access Programs may encounter with audience members. Dr. Haider will moderate the discussion of the 4 cases to include the detection, assessment and treatment of postpartum psychosis and how to discuss and manage this complicated diagnosis with calling obstetricians, primary care providers, pediatricians, and other health care providers during phone consultations with CL psychiatrists. The speakers will integrate evidence-based psychopharmacological management, lifestyle, sleep, caregiving and nutritional interventions within these cases. The last 10 minutes of the workshop will be a Q&A with the four speakers.