剖宫产后诊断为双相情感障碍的患者产后谵妄躁狂：病例报告
Postpartum delirious mania in a patient with diagnosis of bipolar disorder after cesarean delivery: a case report.
摘要(中文译文)
产后抑郁发作较为常见。双相障碍（BD）患者也可能在产后出现躁狂或混合发作，但以快速进展的谵妄、躁狂为特征并可能伴精神病性症状的谵妄性躁狂（DM）病例鲜有报道。鉴于其病情严重、常被漏诊且具有危及生命的风险，深入探讨其临床特征、潜在危险因素及治疗策略有助于临床医生早期识别和干预，从而改善患者预后。我们报告一例罕见的产后谵妄伴躁狂特征的病例。患者为27岁女性，有双相I型障碍病史。她于首次妊娠19周时接受羊膜腔穿刺术，术后第3天出现伴精神病性症状的躁狂发作，经抗精神病药和镇静药物治疗后迅速好转。本次表现发生于其第二次剖宫产术后第2天。她表现出一系列激越症状，包括运动性坐立不安、言语增多、幻听、情绪波动、易激惹、攻击行为及异常兴奋。她还表现出谵妄性躁狂特征，如时间和地点定向障碍、注意力不集中、记忆损害及尿失禁。急诊科初始予丙戊酸钠、喹硫平和丙泊酚治疗无效。入院后改用丙戊酸钠和奥氮平治疗，但疗效仍不理想。然而，在接受电休克治疗（ECT）后，症状迅速改善。出院后6个月的定期随访期间，患者继续接受奥氮平和丙戊酸钠治疗，未再出现躁狂或谵妄症状，总体结局满意。双相障碍且多次分娩的女性发生谵妄性躁狂发作的风险可能增加。电休克治疗（ECT）是快速缓解的有效治疗选择。丙戊酸盐和奥氮平可作为维持治疗方案。
Abstract
Postpartum depressive episodes are common. Patients with bipolar disorder (BD) may also experience manic or mixed episodes postpartum, but cases of delirious mania (DM)-characterized by rapidly evolving delirium, mania, and may involve psychotic symptoms-are rarely reported. Given its severity, frequent underdiagnosis, and life-threatening risks, a thorough exploration of its clinical features, potential risk factors, and treatment strategies can aid clinicians in early recognition and intervention, thereby improving patient outcomes. We report a rare case of postpartum delirium with manic features. The patient was a 27-year-old woman with a history of bipolar disorder type I. She underwent amniocentesis at 19 weeks of her first pregnancy and developed a manic episode with psychotic symptoms on the third postoperative day. She improved rapidly after receiving antipsychotic and sedative medications. This presentation occurred on day 2 following her second cesarean section. She exhibited a series of agitated symptoms including motor restlessness, verbose speech, auditory hallucinations, mood swings, irritability, aggressive behavior, and abnormal excitement. She also demonstrated delirious mania features such as disorientation in time and place, inattention, memory impairment, and urinary incontinence. Initial emergency department treatment with sodium valproate, quetiapine, and propofol proved ineffective. After admission, treatment was switched to sodium valproate and olanzapine, yet outcomes remained suboptimal. However, following electroconvulsive therapy (ECT), symptoms rapidly improved. During regular follow-up visits over 6 months post-discharge, the patient remained free of manic or delirious symptoms while continuing olanzapine and sodium valproate therapy, with overall satisfactory outcomes. Women with bipolar disorder and multiple childbirths may have an increased risk of delirious manic episodes. Electroconvulsive therapy (ECT) is an effective treatment option for rapid relief. Valproate and olanzapine can serve as maintenance therapy regimens.
如何引用
AMA
Bowen Song, Yiwen Yuan, Zhixiong Li, Zhongrui Ma, Xiufang Yang, Zhe Li. Postpartum delirious mania in a patient with diagnosis of bipolar disorder after cesarean delivery: a case report.. Frontiers in psychiatry. 2026; doi:10.3389/fpsyt.2026.1821115.
APA
Bowen Song, Yiwen Yuan, Zhixiong Li, Zhongrui Ma, Xiufang Yang, Zhe Li (2026). Postpartum delirious mania in a patient with diagnosis of bipolar disorder after cesarean delivery: a case report.. Frontiers in psychiatry. https://doi.org/10.3389/fpsyt.2026.1821115
GB/T 7714
Bowen Song, Yiwen Yuan, Zhixiong Li, Zhongrui Ma, Xiufang Yang, Zhe Li. Postpartum delirious mania in a patient with diagnosis of bipolar disorder after cesarean delivery: a case report.[J]. Frontiers in psychiatry, 2026 doi:10.3389/fpsyt.2026.1821115.
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