Tratamiento ambulatorio en una paciente con psicosis puerperal / Ambulatory treatment in a patient with postpartum psychosis

Se presenta el caso clínico de una puérpera que a los 37 días del parto acudió de forma espontánea a la consulta de Ginecología en el Policlínico Docente Municipal de Santiago de Cuba, refiriendo que sentía mucho miedo y sensación de frío intenso en la cabeza, además de no poder dormir bien. El diagnóstico presuntivo fue psicosis puerperal, que se confirmó en la interconsulta con el Departamento de Psicología. La paciente fue tratada con terapia floral y antipsicóticos de manera ambulatoria, y mantuvo seguimiento médico hasta que se le dio el alta. Como factores de riesgo se identificaron la edad mayor de 30 años, y los antecedentes personal y familiar de abandono de la pareja y enfermedad psiquiátrica, respectivamente

The case report of a newly-delivered woman that went spontaneously to the Gynecology Service in the Teaching Municipal Polyclinic in Santiago de Cuba 37 days after the childbirth is presented, referring that she felt a lot of fear and sensation of intense cold in the head, besides that she could not sleep well. The presumptive diagnosis was postpartum psychosis that was confirmed in the Department of Psychology consultation. The patient was treated with floral therapy and antipsychotics in an ambulatory way, and she maintained follow up until she was discharged. Age over 30 years, and the personal and family history of marital break-up and psychiatric disease respectively were identified as risk factors

Diferencias entre la depresión postparto, la psicosis postparto y la tristeza postparto / Differences between postpartum depression, postpartum psychosis and maternity blues

Los trastornos del estado de ánimo del puerperio: tristeza postparto, depresión postparto y psicosis postparto tienen una alta prevalencia, tanto en nuestro país como en otras partes del mundo. Éstos afectan directamente la salud física y emocional de la madre, al igual que la del recién nacido y la pareja, produciendo inestabilidad en el entorno familiar y social de quien la padece. Por lo mismo, se han convertido actualmente en la primera complicación perinatal, así como en un problema de salud pública. El presente artículo muestra una revisión de la literatura e investigaciones más recientes sobre estos padecimientos, con la intención de ayudar al profesional de la salud a detectarlos, diagnosticarlos y, en su caso, tratarlos o canalizar a la mujer con un especialista.

Postpartum mood disorders, like maternity blues, postpartum depression and postpartum psychosis, have a high worldwide prevalence. They have a direct impact on the physical and emotional wellbeing of the mother, the couple and the newborn, and may affect the family and the social environment of the women as well. Therefore, these conditions are currently the most common perinatal complication, and have also become a public health problem. The present article is a detailed review of recent literature and research regarding the afore mentioned mood disorders. Its objective is to assist the health care professional in the detection and diagnosis to these illness, and if needed, treating them or referring the patient to a specialist.

Eletroconvulsoterapia no tratamento da psicose puerperal / Electroconvulsive therapy in puerperal psychosis

A psicose puerperal (PP) é um quadro clínico exuberante, com uma frequência estimada de 1 caso por cada 1.000 puerpérios, e que tem sido associado com maior consistência ao espectro bipolar. A evidência científica disponível é escassa, nomeadamente no respeitante à orientação terapêutica. Os autores apresentam o caso clínico de uma mulher primípara de 28 anos, sem antecedentes psiquiátricos, que iniciou nas primeiras semanas de puerpério um quadro psicótico florido, composto por agitação psicomotora, confusão, desorganização do pensamento e comportamento, sintomatologia psicótica e insônia grave. Por ausência de resposta ao tratamento farmacológico, houve recurso à eletroconvulsoterapia (ECT), com melhoria clínica rápida e evidente. Nesse contexto, os autores realizaram uma apreciação da literatura e evidência referentes ao uso de ECT na psicose puerperal.

Puerperal psychosis (PP) is an exuberant clinical syndrome with an estimated frequency of 1 case per 1,000 childbirths that has been most consistently associated with the bipolar disorders spectrum. Available evidence is scarce, namely regarding management and treatment. The authors present the clinical case of a 28 year-old first-time mother, with no psychiatric history, who developed a florid psychotic syndrome in the first weeks of puerperium. Due to lack of improvement following pharmacological treatment, electroconvulsive therapy (ECT) was applied, with substantial and quick response. In this context, the authors reviewed current literature on the use of ECT for the treatment of puerperal psychosis.