Preventive Interventions for Postnatal Psychosis
Year: 2013
Type: article
Study design: Systematic Review
Abstract: Postnatal psychosis is a worldwide life-threatening condition that affects 1–2 in every 1000 new mothers. It has an abrupt onset within a month of childbirth. Affected new mothers rapidly develop frank psychosis, cognitive impairment, and disorganized behaviors. Factors that increase the risk of postnatal psychosis include primiparous mothers who are single or in older age; have past psychiatric history; and have family history of affective psychosis, prenatal depression, and autoimmune thyroid dysfunction. The risk of a future postnatal recurrence is 25%–57%. Preventive interventions for postnatal psychosis aim at identifying women with risk factors, early recognition of imminent psychosis through screening, and preventive drug therapy. Mood stabilizers, antipsychotic drugs, and hormone therapy may be beneficial in the prevention of postnatal psychotic episodes in women at risk. To investigate the best available evidence for interventions aimed at preventing postnatal psychosis. We searched the Cochrane Schizophrenia Group Trials Register and the Cochrane Central Register of Controlled Trials in October 2012 using the search strategy of the Cochrane Schizophrenia Group. All randomized controlled trials relevant to the prevention of postnatal psychosis Two review authors inspected all citations to ensure reliable selection. We assessed methodological quality of trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Inter ventions. Two review authors would have independently extracted data. For homogenous dichotomous data, we planned to calculate the relative risk, 95% CI, and the number needed to treat/harm on an intention-to-treat basis. There are no included studies in this review. The electronic search produced 3 relevant references, among which we identified 2 old planned trials that seem never to have started and one study that we excluded because it was a report of a case series. This is not an empty review—it is a review full of unanswered questions. Despite growing interest in women’s mental health, the literature in the area of postnatal psychosis is still very limited. It seems that clinicians have no choice but to continue with their current practices guided solely by varied clinical judgment. Women at risk of postnatal psychosis and their relatives are justified to be disappointed in the medical/research fraternity. Post hoc PubMed topic (not methodology specific) search identified mainly case series (table 1). Policy makers have no trial-based evidence upon which to base their guidelines. Certainly, preventive interventions for postnatal psychosis are difficult to justify with confidence without well-designed, well-conducted, and well-reported randomized studies. Available publications suggest that such studies are possible, and funders of research may wish to make this work a priority. Details are available in the full review.11 Nontrial Quantitative Reports—Identified in Post Hoc PubMed Search Nontrial Quantitative Reports—Identified in Post Hoc PubMed Search
Source: Schizophrenia Bulletin
Authors: A. Essali, S. Alabed, A. Guul, N. Essali
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4236412784