Akademik Veri Yönetim Sistemi
ECNP, Barcelona, İspanya, 7 - 10 Ekim 2023, cilt.2, sa.103564, ss.27-28, (Tam Metin Bildiri)
Postpartum psychosis is an acute illness of multifactorial origin and is considered
a psychiatric emergency. With an estimated global prevalence of 0.089 to 2.6 per
1000 births, postpartum psychosis classifies as an illness with a low incidence
rate. However, it carries the potential for serious medical and social consequences,
including the risk of suicide and filicide, if not promptly detected and
treated. The clinical picture of postpartum psychosis includes a wide variety of
rapid-onset psychotic symptoms such as hallucinations and delusions, strange
behavior, confusion, delirium-like disorganization and catatonia [1].In this
article we present a case of postpartum psychosis presenting with catatonia and
responsive to thiamine treatment.
A 30-year-old female patient who was 6 weeks postpartum with no previous
history of psychiatric illness and no significant family history admitted to psychiatry
clinic with loss of apetite, decreased speech amount, psychomotor
retardation, auditory hallucinations and thought disorder (‘’this is not my baby,
my marriage is fake.’’). At her physical examination she had immobility, mutism,
staring, posturing, echopraxia, rigidity, withdrawal, autonomic obedience and
proximal muscle weakness in upper and lower limbs. The Bush-Francis Catatonia
rating scale was 14 points. Additionally in her psychiatric evaluation she had
short-term memory impairment, confusion and confabulation. Initially, lorazepam
was added 7,5 mg/day to treatment for her catatonia, rapid response to
lorazepam was observed. However, no remarkable response was observed to
olanzapine 10 mg/day, her psychotic symptoms and cognitive impairment
remained. Lumbar puncture, brain MRI, PET-MRI, and EEG investigations were
performed for differential diagnosis. Any abnormal finding was not observed
except slightly high protein level in cerebrospinal fluid (CSF). Also screening of
antibodies for autoimmune etiology in CSF and serum resulted negative.
Consideration of postpartum period, poor nutritional intake before hospital
admission due to the catatonic symptoms, cognitive impairment and high serum
lactate level (31,73 mg/dL) and pyruvate level (1,51 mg/dL) with slight acidosis
(pH:7,301), empirical intravenous (IV) thiamine 1500 mg/day infusion was added to treatment for 8 days. During the IV thiamine administrations, her shortterm
memory impairment, confusion and confabulation significantly improved at
fourth day, serum lactate and pyruvate levels turned the normal level at the end
of admissions. With 5 mg/day olanzapine and 500 mg/day oral thiamine treatment,
her psychotic symptoms and proximal muscle weakness in upper and lower
limbs ameliorated. The patient was discharged to be followed up in outpatient
clinic.
When evaluating for thiamine deficiency, the typical history may include poor
nutritional intake, excessive alcohol intake, or the patient belonging to the special
populations (pregnant women, recipients of bariatric surgery, anyone with
poor overall nutritional status, etc.) [2].The present patient indicates that the
possibility of thiamine deficiency should be considered in cases of psychosis and
cognitive impairment especially in peripartum period without classical neurological
disturbance (nystagmus, opthalmoplegia, paresthesias etc.) and high-intensity
T2 MRI lesions [3].
References
[1] Raza SK, Raza S. Postpartum Psychosis. [Updated 2022 Jun 27]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK544304/ [2] Wiley KD, Gupta M.
Vitamin B1 Thiamine Deficiency. [Updated 2022 Jul 22]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK537204/ [3] Sasaki T, Yukizane T,
Atsuta H, Ishikawa H, Yoshiike T, Takeuchi T, Oshima K, Yamamoto N, Kurumaji
A, Nishikawa T. [A case of thiamine deficiency with psychotic symptoms–blood
concentration of thiamine and response to therapy]. Seishin Shinkeigaku Zasshi.
2010;112(2):97-110. Japanese. PMID: 20384190.
No conflict of interest