Prepartum Relapses or Treatment Resistance: A Case of Unipolar Mania

Because of treatment resistance and risks to be considered in the choice of treatment, peripartum psychotic and manic episodes constitute treatment challenges. For perinatal psychosis, there is also the consideration of a substantial subgroup showing the phenomenon of relapse, defined as the recurrence of symptoms after a brief period of symptom reduction. We report prepartum relapses of psychotic manic episodes in a 30-year-old female patient with a 15-year history of bipolar disorder. After 4-month medication-free period due to pregnancy, the patient, who had been in remission for 8 years with a combination of risperidone, valproic acid, and lithium, suffered multiple relapses that could not managed with electroconvulsive therapy and antipsychotic medication. Later, her symptoms only managed with lithium addition to her treatment. In this report, we discuss the treatment of bipolar disorder in pregnancy in the context of prepartum relapse and treatment resistance.