First-Episode Psychosis in a Patient With Flaccid Paraplegia Following Childhood Poliomyelitis - Cureus

We’re sharing this article early to provide faster access to peer-reviewed, accepted research. It is citable and carries a permanent DOI. This version is subject to further edits and will be replaced automatically by the final Version of Record. All legal disclaimers apply. Observational evidence is increasingly central to prognostic precision in early intervention in mental health, particularly in Clinical High-Risk for Psychosis (CHR-P) populations where trajectories are heterogeneous and clinical decisions unfold sequentially. In this context, baseline pharmacological exposure should not be treated merely as a nuisance variable or dismissed because it may reflect confounding by indication, confounding by severity, or protopathic bias. These mechanisms limit causal interpretation, but they may also explain why treatment exposure carries prognostic information. Antipsychotic, antidepressant, benzodiazepine, or combined exposure at CHR-P inception may encode prior clinical deterioration, symptom burden, comorbidity, treatment-seeking pathways, clinician concern, partial treatment response, or pharmacologically attenuated expression of emerging psychosis.

A distinct presentation, a growing evidence base, and specialized clinical expertise support formally recognizing postpartum psychosis in the next DSM update. Mena Mirhom, MD, FAPA, a board-certified psychiatrist and Psychiatric Times section editor, argued that postpartum psychosis should be considered for inclusion in the next iteration or update of the DSM. He said the Lindsay Clancy case and the national conversation around it raise the question for good reason. The DSM-5-TR does not list postpartum psychosis as its own diagnosis. Clinicians instead apply a peripartum-onset specifier to mood disorders, or a postpartum-onset specifier to brief psychotic disorder. Both cover onset during pregnancy or within 4 weeks after delivery.1 Mirhom said the current evidence supports a more specific approach. The Case for InclusionMirhom cited 3 lines of evidence. The first is the nature of the condition itself, which presents in a nuanced and distinct way. The second is the growing research literature on postpartum psychosis.

WARNING: This article contains details about violence against children and suicide. When Meghan Cliffel stepped onto the subway in New York City after work and caught the eyes of her fellow passengers, she felt as though something had gone gravely wrong. While those around her scrolled on their phones or listened to music, the mother-of-two believed they were surveilling her. She switched trains, trying to throw off the supposed pursuers and then continued on to a gathering of old friends. But the unease persisted; eventually, she ran across the city to get home, thinking someone might be about to harm her family when a friend innocuously asked who was watching her daughters, then two and eight months old. "My brain is knitting things together into this kind of complex reality where I believe there's some kind of cultish scheme running the city," she said. "I am in the centre of it in some way and they're out to get me and my kids.

WARNING: This article contains details about violence against children and suicide. The murder trial of Massachusetts mom Lindsay Clancy has forced a spotlight on maternal mental health that some medical experts say may be the only positive outcome in the tragic case. Clancy's defence doesn't dispute that she strangled and killed her three children in 2023 while her then-husband was running an errand, and then attempted to kill herself. But they argue she isn't criminally responsible because she had bipolar disorder and was suffering from postpartum psychosis, a rare and little-understood mental health condition that can affect a new mom's sense of reality. Postpartum psychosis — the sudden onset of psychotic symptoms after childbirth — is much more serious than postpartum depression. Researchers estimate that the condition afflicts one to two women per 1,000 after delivery. The trial has sparked wide-ranging conversations about maternal mental health, and rallies in support of Clancy calling for mental health reform. These conversations are critical because suicide is still one of the leading causes of maternal mortality in the period of time around giving birth, Dr.