Intended for healthcare professionals

Rapid response to:

Clinical Review

Bipolar disorder

BMJ 2012; 345 doi: (Published 27 December 2012) Cite this as: BMJ 2012;345:e8508

Rapid Response:

Re: Bipolar disorder

I found this article really interesting and informative but was disappointed to read the perinatal section. The chances of women suffering from relapses of bipolar disorder in pregnancy and suffering puerperal psychosis (PP) consequently are significantly raised, yet this specific diagnosis was not mentioned, just psychosis vs depression. I think PP should be specifically identified and the familial link highlighted.1

Recent media coverage has shown the devastating consequences when PP is not picked up, arguably this case may well not have been linked with bipolar disorder but it highlights the fatal and awful outcome that PP can present. 2

PP has a direct impact on the mother and the safety of the mother and child, not to mention later bonding and developmental affects to the child. These high risk women need to be made aware of the increased risk of developing PP and need multidisciplinary intervention as soon as possible and preconception advice as mentioned. It is imperative that trusts offer a dedicated perinatal mental health service and ideally access to mother and baby units (MBU) when appropriate. An area we all know is currently a postcode lottery. These dedicated services can then offer the important advice regarding preconception which in keeping with this article is a very difficult area with hard choices to make regarding risks to the developing foetus but also to mother perinatally. Mothers may also benefit from information of organisations offering invaluable support to the dilemmas faced regarding conception and pregnancy.3

1. Am J Psychiatry 2001;158:913-917. 10.1176/appi.ajp.158.6.913
2. (accessed 31/01/13)

Competing interests: No competing interests

01 February 2013
Victoria A Ribbons
Final Year Medical Student
Peninsula College of Medicine and Dentistry
PCMD, Knowledge Spa, RCHT, TR1 3LJ