Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 22, 2017; 7(2): 77-88
Published online Jun 22, 2017. doi: 10.5498/wjp.v7.i2.77
Understanding the pathophysiology of postpartum psychosis: Challenges and new approaches
William Davies
William Davies, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
William Davies, School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom
William Davies, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff CF24 4HQ, United Kingdom
Author contributions: William Davies is the sole contributor to the article.
Supported by Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, No. MR/L010305/1.
Conflict-of-interest statement: The author has no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. William Davies, School of Psychology, Cardiff University, Tower Building 70, Park Place, Cardiff CF10 3AT, United Kingdom. daviesw4@cardiff.ac.uk
Telephone: +44-29-20870152 Fax: +44-29-20874679
Received: November 7, 2016
Peer-review started: November 10, 2016
First decision: January 14, 2017
Revised: February 8, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: June 22, 2017
Abstract

Postpartum psychosis is a severe psychiatric condition which affects 1-2 of every 1000 mothers shortly after childbirth. Whilst there is convincing evidence that the condition is precipitated by a complex combination of biological and environmental factors, as yet the pathophysiological mechanisms remain extremely poorly defined. Here, I critically review approaches that have been, or are being, employed to identify and characterise such mechanisms; I also review a recent animal model approach, and describe a novel biological risk model that it suggests. Clarification of biological risk mechanisms underlying disorder risk should permit the identification of relevant predictive biomarkers which will ensure that “at risk” subjects receive prompt clinical intervention if required.

Keywords: CCN3, Immune system, Steroid sulfatase, Nephroblastoma-overexpressed, Mouse, Animal model, Risk factor

Core tip: Postpartum psychosis is a severe psychiatric condition affecting a small proportion of women shortly after childbirth. The pathophysiological mechanisms underlying risk for the condition are extremely poorly-defined, but may include perturbed immune function, altered tryptophan metabolism and serotonergic dysfunction. Here, I critically review evidence underlying these assumptions, and discuss a novel model for postpartum psychosis risk, involving maternal deficiency for the enzyme steroid sulfatase, and overexpression of the CCN gene family, based upon emerging data from a recently-developed mouse animal model. Identifying and characterising predictive biomarkers for postpartum psychosis risk will help to ensure prompt clinical intervention if required.