Eren YILDIZHAN, Armağan ÖZDEMİR, Hafize Miray AYTAÇ, Nesrin Buket TOMRUK

Prepartum relapses or treatment resistance: a case of unipolar mania

Because of treatment resistance and risks to be considered in the choice of treatment, peripartum psychotic and manic episodes constitute treatment challenges. For perinatal psychosis, there is also the consideration of a substantial subgroup showing the phenomenon of relapse, defined as the recurrence of symptoms after a brief period of symptom reduction. We report prepartum relapses of psychotic manic episodes in a 30-year-old female patient with a 15-year history of bipolar disorder. After 4-month medication-free period due to pregnancy, the patient, who had been in remission for 8 years with a combination of risperidone, valproic acid, and lithium, suffered multiple relapses that could not managed with electroconvulsive therapy and antipsychotic medication. Later, her symptoms only managed with lithium addition to her treatment. In this report, we discuss the treatment of bipolar disorder in pregnancy in the context of prepartum relapse and treatment resistance.

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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth ed. (DSM-5) Koroglu E (Translation Editor). Ankara: Hekimler Yayin Birligi, 2013. (Turkish)

Esquirol JED. Follies: In Panckoucke CLF (editor) Dictionary of Medical Sciences. Paris: Panckoucke, 1816, 192-193. (French)

Brockington I. The Psychoses of Menstruation and Childbearing. New York, Cambridge University Press. 2017, 140-143.

Tohen M, Frank E, Bowden CL, Colom F, Ghaemi SN, Yatham LN, Malhi GS, Calabrese JR, Nolen WA, Vieta E, Kapczinski F, Goodwin GM, Suppes T, Sachs GS, Chengappa KR, Grunze H, Mitchell PB, Kanba S, Berk M. The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009; 11:453-473.

Karadag F, Oral T, Yalcin FA, Erten E. Reliability and validity of Turkish translation of Young Mania Rating Scale. Turk Psikiyatri Derg 2002; 13:107-114. (Turkish)

Leucht S, Davis JM, Engel RR, Kane JM, Wagenpfeil S. Defining “response” in antipsychotic drug trials: recommendations for the use of scale-derived cutoffs. Neuropsychopharmacology 2007; 32:1903-1910.

Fountoulakis KN. Refractoriness in bipolar disorder: definitions and evidence-based treatment. CNS Neurosci Ther 2012; 18:227- 237.

Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A, Zurick A, Cohen LS, Zurick A, Cohen LS. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007; 164:1817-1824.

Ernst CL, Goldberg JF. The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad spectrum psychotropics. J Clin Psychiatry 2002; 63(Suppl. 4):42-55.

Gentile S. Antipsychotic therapy during pregnancy: a systematic review. Schizophr Bull 2010; 36:518-544.

Cetin M. Psychotropic drug use in pregnancy: an update. Bulletin of Clinical Psychopharmacology 2011; 21:161-173.

Trixler M, Gati A, Fekete S, Tenyi T. Use of antipsychotics in the management of schizophrenia during pregnancy. Drugs 2005; 65:1193-1206.

Ozdin S, Boke O, Kocak MB. Sociodemographic features and treatments of pregnant psychiatric inpatients in an university hospital: a retrospective chart review. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2015; 28:96-102.

National Institute for Health and Clinical Excellence (Clinical Guideline 192) Antenatal and postnatal mental health. Clinical management and service guidance 2007., http://www.nice.org. uk/guidance/cg192. Accessed April 4, 2018.

Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML. A reevaluation of risk of in utero lithium exposure. JAMA 1994; 271:146-150.

Jentink J, Loane MA, Dolk H, Barisic I, Garne E, Morris JK, de Jong-van den Berg LT; EUROCAT Antiepileptic Study Working Group. Valproic acid monotherapy in pregnancy and major congenital malformations. N Engl J Med 2010; 362:2185-2193.

Tomson T ve Battino D. Teratogenic effects of antiepileptic drugs. Lancet Neurol 2012; 11:803-813.

Boden R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ 2012; 345:e7085.

Goldsmith DR, Wagstaff AJ, Ibbotson T, Perry CM. Spotlight on lamotrigine in bipolar disorder. CNS Drugs 2004; 18:63-67.

Baldessarini RJ, Tondo L, Vazquez GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry 2019; 24:198- 217.

Haskey C, Galbally M. Mood stabilizers and child development outcomes: a systematic review. Aus N Z J Psychiatry 2017; 51:1087-1097.

National Institute for Health and Clinical Excellence (Clinical Guideline 185). Bipolar disorder: assessment and management 2014 http://www.nice.org.uk/guidance/cg185. Accessed December 15, 2018.

Brockington I, Butterworth R, Glangeaud-Freudenthal N. An international position paper on mother-infant (perinatal) mental health, with guidelines for clinical practice. Arch Womens Ment Health 2017; 20:113-120.