Research Article| Volume 20, ISSUE 5, P479-488, May 1985

Hypercalcemia in the etiology of puerperal psychosis

      This paper is only available as a PDF. To read, Please Download here.


      The serum calcium of 53 recently delivered mothers hospitalized for severe puerperal psychiatric illness, which represented the whole intake from a defined catchement area, was compared with that of 35 female psychiatric patients and that of 49 normal postnatal women.
      The mean corrected and ionized serum calcium values of the puerperal psychiatric patients with no personal or family history of psychiatric disorder were markedly above the normal range. They were also significantly higher than those of the puerperal psychiatric patients with a personal or family history of pscychiatric illness and those of the two control groups. There was a modest positive correlation between the degree of hypercalcemia and the severity of the psychiatric illness. The follow-up of 16 puerperal psychiatric patients indicated that the fall in ionized serum calcium levels correlated positively and significantly with the improvement in rated symptomatology.
      Patients with severe puerperal psychiatric disorder can be divided etiologically into two groups. The larger proportion is psychiatrically vulnerable, but in the remainder (about a third of the total number), the psychiatric illness appears to be related to a disorder of calcium homeostasis in the puerperium.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Anderson J.J.B. Parturient Hypocalcaemia. Academic, Orlando, FL1970
        • Berry E.M.
        • Gupta M.M.
        • Turner S.J.
        • Burns S.R.
        Variations in plasma calcium with induced changes in plasma specific gravity, total protein and albumin.
        Br Med J. 1973; 4: 640-646
        • Bohuon C.
        Microdetermination of magnesium in various biological media.
        Clin Chim Acta. 1962; 7: 811-817
        • Bonnar J.
        • Franklin M.
        • Nott P.N.
        • McNeilly A.S.
        The effect of breast feeding on pituitary-ovarian function after childbirth.
        Br Med J. 1975; 4: 82-84
        • Boonstra C.E.
        • Jackson C.E.
        Hyperparathyroidism detected by routine calcium analysis.
        Ann Intern Med. 1965; 63: 468-474
        • Bratfos D.
        • Haug J.O.
        Puerperal mental disorders in manic-depressive females.
        Acta Psychiatr Scand. 1966; 42: 285-294
        • Carman J.S.
        • Wyatt J.D.
        Calcium: Bivalent cation in the bivalent psychoses.
        Biol Psychiatry. 1979; 14: 295-336
        • Clark J.A.
        • Davidson L.J.
        • Ferguson H.C.
        Psychosis in hypoparathyroidism.
        J Ment Sci. 1962; 108: 811-815
        • Close J.R.
        • Hodge J.S.
        A semi-automated procedure for the determination of calcium using eriochrome blue S.E..
        in: Proc Assoc Clin Biochem. 1967: 253-255
        • Crammer J.L.
        Calcium metabolism and mental disorder.
        Psychol Med. 1977; 7: 557-560
        • de Torrente A.
        • Scherrer J.R.
        Distribution of plasma calcium in 500 patients with mental disturbance.
        Helv Med Acta. 1973; 37: 31-36
        • Dokumov S.I.
        Serum copper and pregnancy.
        Am J Obstet Gynecol. 1968; 101: 217-222
        • Duggin G.G.
        • Lyneham R.C.
        • Dale N.E.
        • Evans R.A.
        • Tiller D.J.
        Calcium balance in pregnancy.
        Lancet. 1974; ii: 926-927
        • Epstein S.
        • Van Mieghem W.
        • Sagel J.
        • Jackson W.P.U.
        The effect of single large doses of oral calcium on serum calcium levels in the young and the elderly.
        Metabolism. 1973; 22: 1163-1173
        • Foulds G.A.
        • Hope K.
        Manual of the Symptom Sign Inventory. University of London Press, London1968
        • Gatewood J.W.
        • Organ C.H.
        • Mead B.T.
        Mental changes associated with hyperparathyroidism.
        Am J Psychiatry. 1975; 132: 129-132
        • Gillin J.C.
        • Carpenter W.T.
        • Hambidge K.M.
        • Wyatt R.J.
        • Henkin R.I.
        Zinc and copper in patients with schizophrenia.
        L'Encephale. 1982; VIII: 435-444
        • Groat R.D.
        • McKenzie T.B.
        The appearance of mania following intravenous calcium replacement.
        J Nerv Ment Dis. 1980; 168: 562-563
        • Jameson S.
        Zinc nutrition and human pregnancy.
        Prog Clin Biol Res. 1983; 129: 53-69
        • Karpati G.
        • Frame B.
        Neuropsychiatric disorders in primary hyperparathyroidism.
        Arch Neurol. 1964; 10: 387-397
        • Keating F.R.
        • Jones J.D.
        Distribution of serum calcium and phosphorus values in unselected ambulatory patients.
        J Lab Clin Med. 1969; 74: 507-514
        • Kendell R.E.
        • Wainwright S.
        • Harley A.
        • Shannon B.
        The influence of childbirth on psychiatric morbidity.
        Psychol Med. 1976; 6: 297-302
        • Kendell R.E.
        • Rennie D.
        • Clark J.A.
        • Dean C.
        The social and obstetric correlates of psychiatric admission in the puerperium.
        Psychol Med. 1981; 11: 341-350
        • King E.J.
        • Wootton I.D.P.
        Microanalysis in Medical Biochemistry.
        ed 3. J & A Churchill, London1950
        • Lowenberg H.
        • Ginsberg T.M.
        Acute hypercalcaemia.
        JAMA. 1932; 99: 1166
        • Marshall R.W.
        Plasma fractions.
        in: Calcium, Phosphate and Magnesium Metabolism. Churchill Livingstone, Edinburgh1976
        • Morgenstern S.
        An automated p-nitrophenylphosphate serum alkaline phosphatase procedure for the autoanalyser.
        Clin Chem. 1965; 11: 876-888
        • Northam B.E.
        • Widdowson G.M.
        Estimation of serum albumin.
        in: Technical Bulletin No. 11. Association of Clinical Biochemical Professional and Scientific Publications, London1967
        • Pedersen K.O.
        On the cause and degree of intraindividual serum calcium variability.
        Scand J Clin Lab Invest. 1972; 30: 191-199
        • Petersen P.
        Psychiatric disturbances in primary hyperparathyroidism.
        J Clin Endocrinol. 1968; 28: 1491-1495
        • Pitkin R.M.
        • Gebhardt M.P.
        Serum calcium concentrations in human pregnancy.
        Am J Obstet Gynecol. 1977; 127: 775-778
        • Reich T.
        • Winokur G.
        Post-partum psychoses in patients with manic-depressive disease.
        J Nerv Ment Dis. 1970; 151: 60-68
        • Tan C.M.
        • Raman A.
        • Sinnathray T.A.
        Serum ionic calcium levels in pregnancy.
        J Obstet Gynaecol Br Common. 1972; 79: 694-697
        • Watney P.J.M.
        • Rudd B.T.
        Calcium metabolism in pregnancy and the newborn.
        J Obstet Gynaecol Br Common. 1974; 81: 210-219
        • Weizman A.
        • Eldar M.
        • Schoenfeld Y.
        • Hirschorn M.
        • Wijsenbeek H.
        • Pinkhas J.
        Hypercalcaemia induced psychopathology in malignant disease.
        Br. J Psychiatry. 1979; 135: 363-366
        • Wills M.R.
        The effect of diurnal variation on total plasma calcium in normal subjects.
        J Clin Pathol. 1970; 23: 772-777