Introduction
A 23-year old suffered from nervous disorders from her menarche. At 21 she married a general, and promptly became pregnant. Seven days after the birth, there was an adverse event. Her lochia were suppressed and she started to rave, but for only 2 days. She relapsed on the 25th day. Délire furieuse switched to stupor. In the 5th month her periods returned and she became obese. In spite of the death of her husband, she remained well.
A 26-year old gave birth to her 1st child. On day 3 she developed furious mania for 2 months. Every spring she showed exaltation without délire. At 30, weaning her second child aged 1 year, she developed furious mania, from which she recovered soon after hospitalisation; but, 2 days after her discharge, she relapsed, recovering after 3 months. At 34 she had a 2-month miscarriage; the next day she became loquacious and developed furious mania that lasted only a few days.
Relapses in the literature
Exclusions
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The recurrence of a prepartum episode after the birth
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Unusual cyclical disorders (Brockington 2014)
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Runge psychoses (Runge 1911)
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Organic psychoses
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Switches from mania to depression or vice versa in a continuous illness
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Deterioration explained by an adverse event such as seizures or psychological trauma.
Enumeration
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Post-abortion 3 (3 %)
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Prepartum 9 (3 %)
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Early postpartum 145 (11 %)
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4–13-week onset 37 (9 %)
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Late onset 13 (6 %)
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Weaning onset 3 (8 %)
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Unknown onset 19 (5 %)
A woman, whose father committed suicide, had a 3-month miscarriage in 1938, and normal births in 1940 and 1944. In 1950 she became clouded in the last month of pregnancy, with poor memory for the birth. In February 1953 she again became clouded, excited and disorientated during pregnancy, this time in the 5th month. She responded to ECT, but relapsed. She gave birth in June and remained confused during the first month of the puerperium, recovered with ECT, then relapsed, with clouding of consciousness, disorientation, insomnia and incoherence. She responded to cortisone treatment.
Multiple relapses
Knowledge of this phenomenon
Years | Episodes with relapses | Non-organic postpartum psychoses | Percentage |
---|---|---|---|
1801–1825 | 2 | 43 | 5 |
1826–1850 | 3 | 73 | 4 |
1851–1875 | 14 | 135 | 10 |
1876–1900 | 10 | 305 | 3 |
1901–1925 | 23 | 391 | 6 |
1926–1950 | 38 | 522 | 7 |
1951–1975 | 73 | 408 | 18 |
1976–present | 25 | 245 | 10 |
Total | 188 | 2122 | 8 |
Language | Cases with relapses | Non-organic postpartum psychoses | Percentage |
---|---|---|---|
French | 85 | 715 | 12 |
American | 26 | 224 | 12 |
Italian | 18 | 198 | 9 |
Other | 20 | 214 | 9 |
German | 26 | 472 | 6 |
British commonwealth | 8 | 211 | 4 |
Dutch | 3 | 88 | 3 |
Clinical details | Onset of psychosis | Recovery | Relapse |
---|---|---|---|
Case 2: early onset of “hallucinatory delirium” with logorrhoea and ideas of her own death and that of her mother | Day 10 | After 5 ECT | Day 25 requiring five more ECT |
Case 4: early onset of agitation with confusion and disorientation. Alternating manic excitation and anxious indifference | Day 3 | With ECT | The same symptoms requiring more ECT |
Case 7: early onset of excitement with incoherence, agitation, delusions of guilt and erotomania. Alternating excitement and stuporose confusion | Day 3 | With ECT | Relapse, no details |
Case 8: confusion and incoherence, then melancholic stupor with euphoria, flight of ideas and logorrhoea | Day 3 | With ECT | Relapse after a week, recovery, 2nd relapse 2 weeks later |
Case 12: agitation, logorrhoea, incoherence, ideas of persecution by her husband, and morbid jealousy | One month after the birth | With ECT | Three relapses |
Case 13: psychosis with polymorphic delusions and extreme excitement | Some days after the birth | Rapid response to ECT | Relapse, no details |
Case 15: manic excitement with mental confusion | One week after the birth | After nine ECT | Relapse a week later, requiring more ECT |
Case 16: stupor, with mutism, food refusal, agitation with auto-accusation, cursing and hating everyone, violence | Day 19 | With ECT | One relapse, no details |
Details of case | Course |
---|---|
Case 1: on day 9, onset of a variable polymorphic state with alternation of depression and poorly systematized delusions of persecution. | Recovery after 20 ECT, relapse with mutism, catatonia, delusions and excitement, requiring more ECT, followed by three more relapses at intervals of 2 months and 3 weeks, requiring further treatment by insulin comas and ECT. |
Case 4: on day 8, she was hospitalized with depression and ideas of cancer; she was disorientated and could hear people speaking to her and the cries of her mother suffering torture. Excitement alternated with stupor and catalepsy. | After nine ECT, her mind cleared. On day 43, her menses appeared, and on day 48, she relapsed and required 15 more ECT. |
Case 5: onset 1 month after the birth: she misidentified people and had hallucinations of people talking all the time. Hospitalized over 4 months later, she was disorientated and had visual and auditory hallucinations. She became excited and, 6 months after the birth, received ECT. | She improved within 2 weeks but relapsed a few days later. ECT was resumed. A state of excitement continued with persecutory ideas, and she was treated with insulin comas. |
Case 7: on day 9, she became excited—laughing, crying and talking incoherently. On day 19, she was hospitalized—disinhibited, euphoric, shouting and dancing. | With 8 ECT, she improved. About a week later, she relapsed, recovered and was discharged 5 months after the birth. |
Case 9: 2 months after the birth, she became disturbed and, after 4 months, was admitted to hospital with excitement, fugues, singing, constant joking, flight of ideas and complete insomnia. | Two weeks later, after the reappearance of her menses, she calmed down. A month later, she relapsed. After ECT, she was discharged 8 months after the birth. |
Case 11: on day 6, she began to say that her husband wanted to get rid of her; she was being poisoned and persecuted by an unknown group. She was sleepless and refused food. | Within a month, after five ECT, she improved. In the 6th week, her menses appeared, and she relapsed with delusional depression, requiring another five ECT. |
Case 12: on day 10, she became manic with flight of ideas, confusion, ideas of persecution and auditory hallucinations. | At 3 weeks, she improved. In the 2nd month, she relapsed, with confusion and food refusal. With 12 ECT, she improved, but, at 3 months, relapsed again. With more ECT, she improved but relapsed 8 months after the birth. |
Case 15: on day 7, she became manic, with shouting, singing, familiarity and exuberance. | Treated with ECT, she improved. Her menses returned at 2 months, preceded by a relapse. She had several phases of excitation. She recovered 9 months after the birth. |
Case 16: after a birth complicated by a fever of 40°, she became agitated, then sank into stupor, mutism and prostration. She claimed that her own child was dead, and this one was not hers. | Treated with ECT, she lost her delusions. Five months after the birth her menses appeared, with a relapse of melancholic delusions and food refusal. She recovered with further ECT. |
Case 20: within a week of the birth, she became depressed with delusions of guilt. | Treated with ECT, she improved, but a month later relapsed with excitation. After 25 insulin comas, she recovered. |