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Clozapine Efficacy in a Case of Severe Treatment-Resistant Postpartum Psychosis

Authors Teodorescu A, Ifteni P, Dragan A, Moga MA, Miron AA, Dima L

Received 30 November 2020

Accepted for publication 18 January 2021

Published 12 February 2021 Volume 2021:14 Pages 555—559


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Marco Carotenuto

Andreea Teodorescu,1 Petru Ifteni,1 Ana Dragan,2 Marius Alexandru Moga,1 Ana Aliana Miron,1 Lorena Dima1

1Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania; 2Clinical Hospital of Psychiatry and Neurology of Brasov, 3rd Department of Clinical Psychiatry, Brasov, Romania

Correspondence: Petru Ifteni
Transilvania University of Brasov, Faculty of Medicine, 29th Eroilor Bvd, Brasov, Romania
Tel +40724993329

Background: The postpartum period is a difficult time for mother and family. Unfortunately, in some cases, two psychiatric complications may occur: postpartum psychoses (PPP) with a prevalence of 0.2% and a very low incidence of 0.25– 0.50 per 1000 deliveries, and post-natal depressions with an incidence of 10 to 20% per 1000 deliveries. The onset of postpartum psychosis is in the first 4 weeks after childbirth with symptoms such as emotional lability, cognitive disorganization, delusional beliefs and hallucinations. It requires hospitalization due to the high risk of suicide and infanticide. The studies reveal that the treatment can include FGAs (first-generation antipsychotics), such as haloperidol, and SGAs (second-generation antipsychotics), such as olanzapine, quetiapine and risperidone. The literature is scarce in what resistant PPP is concerned and no such cases treated with clozapine have been reported, according to our knowledge. The present case report focuses on a female diagnosed with PPP who was treated with clozapine due to the lack of response to adequate dosage of 2 second-generation antipsychotics.
Case Presentation: We present the case of a 30-year-old primiparous woman on her 3rd day after delivery, admitted in the psychiatric emergency unit for agitation, intrusive thoughts with a content frequently related to the infant, ideas of reference, disorganized speech, bizarre behavior, verbal stereotypes, insomnia and anxiety. Due to lack of response to adequate dosage of 2 second-generation antipsychotics, clozapine was initiated up to 250 mg/day. The symptoms remitted in the next 5 days and the patient was discharged. After discharge, at the patient’s request, clozapine was replaced by olanzapine. Visit at 1 year revealed full remission of symptoms.
Conclusion: Although data is extremely limited, clozapine has been shown to be effective and safe in a severe case of treatment-resistant PPP.

Keywords: postpartum psychosis, antipsychotics, clozapine, suicide, treatment-resistant

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