Bergink et al. (Reference Bergink, Laursen, Johannsen, Kushner, Meltzer-Brody and Munk-Olsen2015) report that, in Denmark in 17 years, 6.5% of mothers, who received psychiatric treatment during the first 3 months after the birth, had pre-eclampsia, compared to 4.3% of other mothers (an additional 24 cases in a series of 1087). They excluded eclampsia, but eclamptic psychosis is not the only psychotic complication of gestosis. There is also the symptomatic psychosis described by Donkin (Reference Donkin1863). This was mentioned on page 144 of Motherhood and Mental Health (Brockington, Reference Brockington1996) (which they have cited), and has been described in more detail in subsequent publications (Brockington, Reference Brockington2006, Reference Brockington2014). I had 13 possible ‘Donkin psychoses’ in my series of 321 childbearing psychoses, a similar proportion to this Danish series. Postpartum psychoses are complex, a complexity that is hidden in epidemiological samples. Eclamptic and Donkin psychoses are among about 20 distinct diseases leading to childbearing episodes. Since they are neuropsychiatric disorders, due to transient arteriolar spasm and microthrombosis (Roberts, Reference Roberts1998), there is no need to invoke the immune mechanisms that some believe are involved in puerperal bipolar disorders (Bergink et al. Reference Bergink, Gibney and Drexhage2014).
Declaration of Interest
None.
