27th National Clinical Education Symposium Presentation Abstracts
29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2
Rapid-onset postpartum mania in twin pregnancy
Ceyhan Akkeyik1, Ayşe Döndü1
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1. Department of Psychiatry, Adnan Menderes University, Aydın, Turkey
DOI: 10.5080/kes27.abs124 Page 150
OBJECTIVE Bipolar disorder is a chronic, recurrent affective disorder marked by manic, hypomanic, and depressive episodes. In women, childbirth significantly influences its onset and trajectory. Clinical and genetic evidence suggests postpartum psychosis represents a bipolar manifestation. This case explores the rapid onset of postpartum mania with psychotic features following twin delivery, highlighting the interplay between perinatal factors and bipolar disorder's pathophysiology. CASE A 26-year-old married woman, a university graduate and mother of two, was brought to the emergency department with irritability and excessive talking. Her symptoms began after the cesarean delivery of her monozygotic twins. Within two weeks, she developed persecutory and grandiose delusions, alongside manic symptoms such as irritability, pressured speech, and behavioral changes. She was admitted for further evaluation. Laboratory tests, EEG, and MRI were unremarkable. There was no personal or family psychiatric history. She was diagnosed with manic attack with psychotic features with peripartum onset and treated with Olanzapine (5 mg/day), Biperiden (2 mg/day), Haloperidol (2.5 mg/day), and Quetiapine (12.5 mg/day). Her symptoms improved significantly within six days, allowing discharge with continued outpatient treatment. Informed consent was obtained. DISCUSSION The etiology of postpartum mood disorders and psychotic episodes is multifactorial, with hormonal changes playing a crucial role. During pregnancy, estrogen and progesterone levels rise exponentially and drop sharply after delivery. Estrogen influences the hypothalamic dopaminergic system, and its decline may increase dopamine receptor sensitivity, potentially triggering psychotic symptoms. Animal studies suggest postpartum glucocorticoid secretion is regulated by the dopaminergic system. High oxytocin metabolite levels have been detected in postpartum mania. In this case, the rapid onset of psychotic mania following twin delivery suggests a hormonal trigger. Postpartum psychosis is primarily linked to bipolar disorder, often coinciding with reproductive years. In our case, a manic episode with psychotic features and peripartum onset was the most appropriate diagnosis.