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Sheng B, Jiang G, Ni J. Association between postpartum depression and postpartum hemorrhage: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024. [PMID: 38475881 DOI: 10.1111/aogs.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Postpartum depression (PPD) is a growing mental health concern worldwide and has detrimental effects on the social and cognitive health of both mothers and infants. This review was performed to assess the risk of PPD in women with postpartum hemorrhage (PPH) and to identify potential moderators. MATERIAL AND METHODS The review protocol was registered in the PROSPERO database on June 17, 2023 (registration number: CRD42023432955). Two researchers independently performed a literature search of the PubMed, Embase, and Web of Science databases for articles published before May 25, 2023, with no filters and no language or location restrictions. Study quality was evaluated using the Newcastle-Ottawa Scale. The primary outcome was the odds ratio (OR) and 95% confidence interval (CI) of PPD in women with vs. without PPH. We performed sensitivity analyses and meta-regression analyses to resolve heterogeneity. Meta-regression analyses included the effects of age, maternal smoking, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, and cesarean section. RESULTS In total, seven studies involving 540 558 participants met the eligibility criteria and were included in the meta-analysis. Women with PPH were at increased risk of PPD compared with women without PPH (OR 1.10; 95% CI 1.03-1.16), and heterogeneity was low (I2 = 23%; τ2 = 0.0007; p = 0.25). Moreover, the results of the sensitivity analyses showed that the I2 value decreased from 23% to 0% after excluding one particular study, which may have been a source of heterogeneity. In the meta-regression analyses, the OR of PPD was greatly affected by maternal smoking (OR -0.26; 95% CI -0.30 to -0.22; p < 0.001). However, we did not observe any effects for maternal age, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, or cesarean section. CONCLUSIONS Women with PPH must be closely monitored because they have a higher risk of PPD than women without PPH. Early recognition and management of these patients will improve treatment outcomes, maternal health, and newborn development.
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Affiliation(s)
- Bo Sheng
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, City of Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, City of Chengdu, Sichuan, China
| | - Guoguo Jiang
- Department of Hospital Infection Management, The Second Hospital of Chengdu City, City of Chengdu, Sichuan, China
| | - Juan Ni
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, City of Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, City of Chengdu, Sichuan, China
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West T, Christopher J, Arkhipov S, Erickson D, Fitzsimmons A. Posterior Reversible Encephalopathy Syndrome Presenting as Delirium With Psychosis and Agitation in the Postpartum Period. Cureus 2024; 16:e56731. [PMID: 38646354 PMCID: PMC11032752 DOI: 10.7759/cureus.56731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES), which was first described in 1996, is a neurologic condition characterized by a combination of clinical and neuroimaging findings. PRES may arise in the context of preeclampsia, eclampsia, renal failure, and sepsis, among other conditions. Neuropsychiatric symptoms of PRES include altered mental status, agitation, and in some cases psychosis. PRES occurring in the postpartum period is understudied, especially with regard to its psychiatric manifestations. We aim to add to the literature a case of PRES associated with psychosis and agitation in a postpartum woman, highlighting clinical implications and offering suggestions for practice. A female in her late 20s, with no significant psychiatric or medical history, presented to the hospital at 29 weeks and one day of gestation following a witnessed seizure. She was found to be hypertensive and hyponatremic, was diagnosed with eclampsia, and underwent an emergent cesarean section due to fetal malpresentation. The next day, the patient developed paranoia with acute agitation, and the psychiatry team diagnosed her with delirium with psychosis/agitation secondary to her underlying medical condition. She required intramuscular medications for agitation, was placed in restraints, and was transferred to the ICU for sedation. Subsequently, CT and MRI scans of her head both indicated that she had developed PRES. The patient's delirium and psychotic behavior resolved after appropriate treatment of her eclampsia. To our knowledge, this case report is the second documented case in the literature, of a patient who presented with PRES characterized by agitation and psychotic features in the postpartum period. Due to the significant overlap in symptoms between delirium and postpartum psychosis, this case highlights the crucial importance of interdisciplinary collaboration for accurate diagnosis and prompt treatment of PRES in the postpartum period. The case also speaks to the importance of differentiating postpartum psychosis associated with a primary psychiatric disorder from delirium arising in postpartum patients with or without a previous psychiatric history.
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Affiliation(s)
- Talitha West
- Psychiatry, Hackensack Meridian Ocean University Medical Center, Brick, USA
| | - Jason Christopher
- Psychiatry, Hackensack Meridian Jersey Shore University Medical Center, Neptune, USA
| | - Stanislav Arkhipov
- Internal Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, USA
| | - Daniel Erickson
- Psychiatry, Hackensack Meridian School of Medicine, Nutley, USA
| | - Adriana Fitzsimmons
- Psychiatry, Hackensack Meridian Jersey Shore University Medical Center, Neptune, USA
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3
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Iyengar U, Hunt J. An Open Conversation About Postpartum Psychosis: An Interview with Jessie Hunt: Communications Lead, Advocate, and Expert by Experience. Yale J Biol Med 2024; 97:107-112. [PMID: 38559459 PMCID: PMC10964824 DOI: 10.59249/pwxz3821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Postpartum psychosis is a mental illness that is often misunderstood and stigmatized and can have a devastating impact on the women affected and their families, particularly when not identified and treated early on. The first-person perspective of experiencing a mental illness such as postpartum psychosis is remarkably powerful and can shed light on some of the hidden or misunderstood aspects of diagnosis, treatment, recovery, and getting support. With this in mind, we have prepared this interview from both an academic and lived experience perspective of postpartum psychosis, for clinicians, academics, mental health professionals, and members of the public.
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Affiliation(s)
- Udita Iyengar
- Department of Psychosis Studies, King’s College London, London, UK
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4
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Biaggi A, Hazelgrove K, Waites F, Bind RH, Lawrence AJ, Fuste M, Conroy S, Howard LM, Mehta MA, Miele M, Seneviratne G, Pawlby S, Pariante CM, Dazzan P. Mother-infant interaction and infant development in women at risk of postpartum psychosis with and without a postpartum relapse. Psychol Med 2024; 54:823-834. [PMID: 37706314 DOI: 10.1017/s0033291723002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND This study aimed to investigate mother-infant interaction and infant development in women at-risk of postpartum psychosis (PP), with and without a postpartum relapse. METHODS 103 women (and their offspring) were included, 43 at-risk-of-PP because of a diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 60 with no current/previous mental illness or family history of PP. Of the at-risk women, 18 developed a psychiatric relapse within 4 weeks after delivery (AR-unwell), while 25 remained symptom-free (AR-well). Mother-infant interaction was assessed using the CARE-Index at 8 weeks' and 12 months' postpartum and infant development using the Bayley-III at 12 months' postpartum. RESULTS Women at-risk-of-PP as a group, regardless of whether they developed a psychiatric relapse within 4 weeks after delivery, had less synchronous mother-infant interactions and had infants with less optimal cognitive, language, motor and socio-emotional development than healthy controls. In particular, boys of at-risk women had the lowest scores in cognitive, language and motor development and in mother-infant interaction, while girls of the at-risk women had the lowest scores in socio-emotional development. The synchrony in the dyad predicted infant cognitive and language development. There was no evidence for a difference in mother-infant interaction nor in infant development between the AR-unwell and AR-well groups. CONCLUSIONS These results suggest that, while there is a lack of evidence that an early postpartum relapse in women at-risk-of-PP could represent a risk for the infant per se, maternal risk for PP may be associated with less optimal mother-infant interaction and infant development.
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Affiliation(s)
- Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Montserrat Fuste
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London, IG3 8XD, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Mitul A Mehta
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, SE5 8AF, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, W2 1PF, UK
| | - Gertrude Seneviratne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Tsokkou S, Kavvadas D, Georgaki MN, Papadopoulou K, Papamitsou T, Karachrysafi S. Genetic and Epigenetic Factors Associated with Postpartum Psychosis: A 5-Year Systematic Review. J Clin Med 2024; 13:964. [PMID: 38398277 PMCID: PMC10888625 DOI: 10.3390/jcm13040964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
Purpose: Postpartum psychosis (PPP) is a serious mental health illness affecting women post-parturition. Around 1 in 1000 women are affected by postpartum psychosis, and the symptoms usually appear within 2 weeks after birth. Postpartum mental disorders are classified into 3 main categories starting from the least to most severe types, including baby blues, postpartum depression, and postpartum psychosis. Materials and Methods: In this systematic review, genetic and epigenetic factors associated with postpartum psychosis are discussed. A PRISMA flow diagram was followed, and the following databases were used as main sources: PubMed, ScienceDirect, and Scopus. Additional information was retrieved from external sources and organizations. The time period for the articles extracted was 5 years. Results: Initially, a total of 2379 articled were found. After the stated criteria were applied, 58 articles were identified along with 20 articles from additional sources, which were then narrowed down to a final total of 29 articles. Conclusions: It can be concluded that there is an association between PPP and genetic and epigenetic risk factors. However, based on the data retrieved and examined, the association was found to be greater for genetic factors. Additionally, the presence of bipolar disorder and disruption of the circadian cycle played a crucial role in the development of PPP.
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Affiliation(s)
- Sophia Tsokkou
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.T.); (D.K.); (M.-N.G.); (K.P.); (T.P.)
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios Kavvadas
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.T.); (D.K.); (M.-N.G.); (K.P.); (T.P.)
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Maria-Nefeli Georgaki
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.T.); (D.K.); (M.-N.G.); (K.P.); (T.P.)
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Kyriaki Papadopoulou
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.T.); (D.K.); (M.-N.G.); (K.P.); (T.P.)
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- A’ Neurosurgery University Clinic, Aristotle University of Thessaloniki, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theodora Papamitsou
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.T.); (D.K.); (M.-N.G.); (K.P.); (T.P.)
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sofia Karachrysafi
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.T.); (D.K.); (M.-N.G.); (K.P.); (T.P.)
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Lyons T, Hennesey T, Noonan M. A systematic review of qualitative evidence: Perspectives of fathers whose partner experienced postpartum psychosis. J Adv Nurs 2024; 80:413-429. [PMID: 37658618 DOI: 10.1111/jan.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023]
Abstract
AIMS This study aimed to systematically identify, appraise and synthesize qualitative evidence which explored fathers' experiences and perspectives of their partners' postpartum psychosis. DESIGN Qualitative evidence synthesis (QES). DATA SOURCES Seven databases (CINAHL, PsycINFO, Medline, Scopus, Google Scholar, ProQuest Dissertations and Open Grey) were systematically searched for qualitative studies from each database's inception to the 17th of February 2022. REVIEW METHODS Studies that utilized a qualitative research design to explore fathers' experiences and perspectives of their partners' postpartum psychosis were included. Studies were appraised using the Critical Appraisal Skills Programme to determine their methodological quality. Qualitative data were extracted and synthesized using the process of thematic synthesis to form analytical themes. RESULTS Eleven reports (seven journal articles and four theses), representing six unique qualitative studies were included in the review. Two analytical themes and eight subthemes were identified. The analytical themes were 'a sense of loss across multiple domains of their lives', and 'informational and emotional support needs'. CONCLUSION Postpartum psychosis is a severe mental health condition which also impacts the woman's partner. Fathers experienced an array of emotions which they attributed to a lack of knowledge and understanding of postpartum psychosis. The development of appropriate support structures is needed to better support fathers in supporting their partners. REPORTING METHOD This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and ENTREQ reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution. IMPACT WHAT PROBLEM DID THIS STUDY ADDRESS?: Fathers play a pivotal role in supporting their partner who has postpartum psychosis, and a supportive father has a positive impact on the mental health of the mother. Several qualitative studies have explored fathers' experiences of their partners' psychosis. This QES integrated findings from these studies to gain a deeper understanding and knowledge of the father's experience. WHAT ARE THE MAIN FINDINGS?: Fathers reported a significant sense of loss across multiple domains of their lives, from a perceived loss of their relationship with their partner to a loss of the future they had planned together. Fathers experienced an array of emotions, such as fear and shock which they attributed to their lack of knowledge and awareness of postpartum psychosis. WHERE AND ON WHOM WILL THIS RESEARCH HAVE AN IMPACT?: This review provides a deeper insight and understanding into the father's experiences and perspectives of their partners' postpartum psychosis. This insight can inform healthcare professionals and policymakers in the development of appropriate support structures which meet the needs of this population. The provision of appropriate support structures could have a positive impact on the father's well-being and ability to support their partner.
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Affiliation(s)
- Theresa Lyons
- Louth Meath Mental Health Services, Community Healthcare Organisation 8, Dublin, Ireland
| | - Therese Hennesey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Fulton A, Mittal N, Deb A. Postpartum Psychosis as a Consequence of Thyroiditis Versus Relapse: A Diagnostic Dilemma. Cureus 2024; 16:e52357. [PMID: 38361668 PMCID: PMC10867710 DOI: 10.7759/cureus.52357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Thyrotoxicosis can exhibit overlapping symptoms of psychosis in the general population. Each of these pathologies has well-established workups and management. Rare presentations of thyroiditis and psychosis in the postpartum state have been seen in case studies mostly, but data on the prevalence of postpartum psychosis in association with postpartum thyroiditis are not available. Here, we present a unique case of a patient with a history of bipolar disorder who originally presented with postpartum thyroiditis that was worked up and managed appropriately. However, on follow-up, the patient was found to have progressed into prominent psychosis. Both thyroiditis and psychosis were managed individually with full remission upon discharge and is doing well today. The co-occurrence of postpartum psychosis and thyroiditis presents a unique challenge for timely diagnosis and management. We present a case of a young woman initially diagnosed with postpartum thyroiditis needing further management of postpartum psychosis due to persistent symptoms. Clinical presentation supported with a prior history of mood disorder increases the likelihood of these diagnoses together.
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Affiliation(s)
- Alec Fulton
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Neha Mittal
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Anasua Deb
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
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Carr C, Borges D, Lewis K, Heron J, Wilson S, Broome MR, Jones I, Di Florio A, Morales-Muñoz I. Sleep and Postpartum Psychosis: A Narrative Review of the Existing Literature. J Clin Med 2023; 12:7550. [PMID: 38137618 PMCID: PMC10744103 DOI: 10.3390/jcm12247550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Sleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP.
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Affiliation(s)
- Camilla Carr
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
| | - Daniela Borges
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
- Coventry and Warwickshire Partnership NHS Trust, Coventry CV6 6NY, UK
| | - Katie Lewis
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff CF24 4HQ, UK
| | - Jessica Heron
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
- Action on Postpartum Psychosis, Swansea SA3 9BT, UK
| | - Sally Wilson
- Action on Postpartum Psychosis, Swansea SA3 9BT, UK
| | - Matthew R. Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff CF24 4HQ, UK
| | - Arianna Di Florio
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff CF24 4HQ, UK
| | - Isabel Morales-Muñoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
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Backer S, Yancheva J, Garcia C, Khanna D. Thyroid Predictors of Postpartum Mood Disorders. Cureus 2023; 15:e45554. [PMID: 37868409 PMCID: PMC10586527 DOI: 10.7759/cureus.45554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Postpartum mood disorders (PMD) are currently among the leading causes of maternal postpartum morbidity and mortality. PMD include the conditions of postpartum blues (PB), postpartum depression (PPD), and postpartum psychosis. The pathogenesis of PMDs are ambiguous, and there are no reliable prenatal predictive markers despite current research efforts. Even though reliable indicators have not been found, leading ideas suggest an etiology of hormonal fluctuations. Although thyroid markers have long been linked to psychiatric disorders such as major depressive disorder (MDD), how they correlate with PMDs is still unclear. This study aimed to evaluate the pathophysiological link between thyroid function, PMDs, and the usefulness of thyroid markers as indicators of their occurrence and severity. The methodology consisted of a narrative literature review. Several inclusion and exclusion criteria were used to filter the results of literature searches in PubMed. Studies were included if they discussed any marker related to thyroid endocrinology in relation to the incidence or pathophysiology of any PMD. Both primary and secondary analyses were included. The permissive inclusion criteria were used due to the relative scarcity of research on the topic and the ambiguous pathophysiology of PMD. The results demonstrated the potential utility of thyroid autoimmunity as a predictor of late-onset PPD. Hypothyroidism, low euthyroid hormone levels, and the presence of thyroid autoantibodies were correlated with increased incidence of PPD and late postpartum depressive symptoms, past the timeline of PB. Most notably a rapid postpartum drop in cortisol level may precipitate thyroid autoimmunity in anti-thyroid peroxidase (TPO) antibody positive women, which could eventually produce a hypothyroid phase associated with depressive symptoms. There was insufficient evidence to suggest a relationship with postpartum psychosis. In conclusion, the exact pathophysiological mechanisms of PMDs remain ambiguous, but TPO-antibodies in the third trimester may be a predictor of late PPD.
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Affiliation(s)
- Sean Backer
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa, USA
| | - Janeta Yancheva
- Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Camelia Garcia
- Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Deepesh Khanna
- Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
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Albers SM, Wen T, Monk C, Logue TC, D'Alton ME, Booker WA, Friedman AM. Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016-2019. Am J Obstet Gynecol MFM 2023; 5:100905. [PMID: 36775196 DOI: 10.1016/j.ajogmf.2023.100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Up-to-date data on population-level risk factors for postpartum psychosis is limited, although increasing substance use disorders, psychiatric disorders, autoimmune disorders, and other medical comorbidities in the obstetrical population may be contributing to the increased baseline risk of postpartum psychosis. OBJECTIVE This study aimed to determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions. STUDY DESIGN Analyzing the 2016-2019 Nationwide Readmission Database, this repeated cross-sectional study identified diagnoses of postpartum psychosis during delivery hospitalizations and postpartum readmissions within 60 days of discharge. The relationship among demographic, clinical, and hospital-level factors present at delivery and postpartum psychosis was analyzed with logistic regression models with adjusted odds ratios with 95% confidence intervals as measures of association. Separate models were created for postpartum psychosis diagnoses at delivery and during postpartum readmission. Temporal trends in diagnoses were analyzed with Joinpoint regression to determine the average annual percent change with 95% confidence intervals. RESULTS Of 12,334,506 deliveries in the analysis, 13,894 (1.1 per 1000) had a diagnosis of postpartum psychosis during the delivery hospitalization, and 7128 (0.6 per 1000) had a 60-day postpartum readmission with postpartum psychosis. Readmissions with postpartum psychosis increased significantly during the study period (P=.046). Most readmissions with a postpartum psychosis diagnosis occurred in 0 to 10 days (43% of readmissions) or 11 to 20 days (18% of readmissions) after discharge. Clinical factors with the highest adjusted odds for postpartum psychosis readmission included delivery postpartum psychosis (adjusted odds ratio, 5.8; 95% confidence interval, 4.2-8.0), depression disorder (adjusted odds ratio, 3.7; 95% confidence interval, 3.3-4.2), bipolar spectrum disorder (odds ratio, 2.9; 95% confidence interval, 2.3-3.5), and schizophrenia spectrum disorder (adjusted odds ratio, 2.9; 95% confidence interval, 2.1-4.0). In models analyzing postpartum psychosis diagnoses at delivery, risk factors associated with the highest odds included anxiety disorder (adjusted odds ratio, 3.9; 95% confidence interval, 3.5-4.2), schizophrenia spectrum disorder (adjusted odds ratio, 2.5; 95% confidence interval, 1.9-3.4), bipolar disorder (adjusted odds ratio, 1.8; 95% confidence interval, 1.6-2.1), stillbirth (odds ratio, 3.6; 95% confidence interval, 3.1-4.2), and substance use disorder (odds ratio, 1.7; 95% confidence interval, 1.6-1.9). In addition, chronic conditions, such as pregestational diabetes mellitus, obesity, and substance use, were associated with delivery and readmission postpartum psychosis. CONCLUSION This study determined that postpartum psychosis is increasing during postpartum readmissions and is associated with a wide range of obstetrical and medical comorbidities. Close follow-up care after delivery for other medical and obstetrical diagnoses may represent an opportunity to identify postpartum psychiatric conditions, including postpartum psychosis.
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Affiliation(s)
- Saundra M Albers
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Wen)
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman); New York State Psychiatric Institute, New York, NY (Dr Monk)
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman).
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11
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Rossi NM, Radney L. Diagnosis and Management of Perinatal Depression. Nurs Womens Health 2022; 26:318-30. [PMID: 35714763 DOI: 10.1016/j.nwh.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.
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Kowalczyk OS, Pauls AM, Fusté M, Williams SCR, Hazelgrove K, Vecchio C, Seneviratne G, Pariante CM, Dazzan P, Mehta MA. Neurocognitive correlates of working memory and emotional processing in postpartum psychosis: an fMRI study. Psychol Med 2021; 51:1724-1732. [PMID: 32174288 DOI: 10.1017/s0033291720000471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postpartum psychosis (PP) is a severe postpartum disorder. While working memory and emotional processing-related brain function are consistently impaired in psychoses unrelated to the puerperium, no studies have investigated them in PP. METHODS Twenty-four women at risk of developing PP (11 developed an episode - PE; 13 remained well - NPE) and 20 healthy postpartum women completed two functional magnetic resonance imaging tasks within a year of delivery: working memory (n-back) and emotional face recognition (fearful faces). We compared women at-risk of PP to controls, as well as NPE, PE, and controls to test for potential effects of a PP episode occurrence. RESULTS Women at-risk of PP and PE showed hyperactivation of lateral visual areas, precuneus, and posterior cingulate during the n-back task. The at-risk group as a whole, as well as the PE and NPE groups, showed hyperconnectivity of the right dorsolateral prefrontal cortex (DLPFC) with various parieto-occipito-temporo-cerebellar regions compared to controls during several n-back conditions. Increases in connectivity between the right DLPFC and ipsilateral middle temporal gyrus were observed in the PE group compared to NPE during 2-back. During the fearful faces task, at-risk women as a group showed hyperactivation of fronto-cingulo-subcortical regions, and hypoconnectivity between the left amygdala and ipsilateral occipito-parietal regions compared to controls. No significant performance differences were observed. CONCLUSIONS These results present preliminary evidence of a differential nature of functional brain abnormalities in PP compared to the typically observed reduced connectivity with the DLPFC in psychoses unrelated to puerperium, such as bipolar disorder.
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Affiliation(s)
- Olivia S Kowalczyk
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Astrid M Pauls
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Steven C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Katie Hazelgrove
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
| | - Costanza Vecchio
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
| | - Gertrude Seneviratne
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
| | - Carmine M Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Sethy RR, Garg S, Ram D, Tikka SK. Thyroid function in postpartum psychosis: An exploratory study. Asia Pac Psychiatry 2021; 13:e12465. [PMID: 33742554 DOI: 10.1111/appy.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 02/10/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
The study aimed to compare thyroid function between psychosis with postpartum onset (PPO), psychosis without postpartum onset (PWPO), and normal postpartum females (HC). Twenty women were recruited in each of the three groups. The PPO group had significantly greater psychopathology and shorter episodes compared to the PWPO group. The PPO group was found to have significantly greater right lobe volume than the other groups. The PPO group also had significantly higher FT4 levels than the HC group. We conclude that isolated increase in FT4 and thyroid lobe volumetric changes could be more specifically associated with psychosis of post-partum onset.
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Affiliation(s)
| | - Shobit Garg
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Raipur, India
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14
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Yadawad V, Ganjekar S, Thippeswamy H, Chandra PS, Desai G. Short-term outcome of mothers with severe mental illness admitted to a mother baby unit. Indian J Psychiatry 2021; 63:245-249. [PMID: 34211217 PMCID: PMC8221211 DOI: 10.4103/psychiatry.indianjpsychiatry_1005_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/22/2020] [Accepted: 05/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mother baby psychiatry units (MBUs) are the expected standard of inpatient care internationally for postpartum mothers with severe mental illness (SMI) and favorable outcomes for mother infant dyads have been reported from these services. However, there are very few such units in low- and middle-income countries. The current study aimed to assess the short-term outcome of mothers in SMI admitted to an MBU in India. MATERIALS AND METHODS Mother infant dyads admitted over a year in the MBU were assessed in detail at admission, discharge, and at 3 months. Tools used included the Brief Psychiatric Rating Scale (BPRS), Young's Mania Rating Scale, Edinburgh Postnatal Depression Scale, and Clinical Global Impression. Mother infant interaction was assessed using the NIMHANS maternal behavior scale. RESULTS The mean age of the 43 mothers admitted in this period was 27.3 ± 6.2 years. For 27 (62.8%) mothers, this was a first episode of psychosis. Affective disorders and acute psychotic disorders were the most common diagnoses. The average duration of stay in the MBU was 25 days. While all mothers showed significant improvement at discharge, mothers with a first episode in the postpartum had higher BPRS scores (Ws = 309.5, P = 0.02) as compared to the others. At 3 months following discharge, all mothers sustained the improvement achieved. DISCUSSION Mothers with SMI admitted to an MBU showed significant clinical and dyadic improvement at discharge which was sustained at 3 months. However, the lack of a control group limits the generalizability of the current findings. CONCLUSION The study highlighted a favorable short-term outcome among mothers with SMI admitted to a MBU facility.
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Affiliation(s)
- Vishwas Yadawad
- Department of Psychiatry, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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15
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Teodorescu A, Ifteni P, Dragan A, Moga MA, Miron AA, Dima L. Clozapine Efficacy in a Case of Severe Treatment-Resistant Postpartum Psychosis. Risk Manag Healthc Policy 2021; 14:555-559. [PMID: 33603521 PMCID: PMC7886290 DOI: 10.2147/rmhp.s294249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 01/29/2023] Open
Abstract
Background The postpartum period is a difficult time for mother and family. Unfortunately, in some cases, two psychiatric complications may occur: postpartum psychoses (PPP) with a prevalence of 0.2% and a very low incidence of 0.25–0.50 per 1000 deliveries, and post-natal depressions with an incidence of 10 to 20% per 1000 deliveries. The onset of postpartum psychosis is in the first 4 weeks after childbirth with symptoms such as emotional lability, cognitive disorganization, delusional beliefs and hallucinations. It requires hospitalization due to the high risk of suicide and infanticide. The studies reveal that the treatment can include FGAs (first-generation antipsychotics), such as haloperidol, and SGAs (second-generation antipsychotics), such as olanzapine, quetiapine and risperidone. The literature is scarce in what resistant PPP is concerned and no such cases treated with clozapine have been reported, according to our knowledge. The present case report focuses on a female diagnosed with PPP who was treated with clozapine due to the lack of response to adequate dosage of 2 second-generation antipsychotics. Case Presentation We present the case of a 30-year-old primiparous woman on her 3rd day after delivery, admitted in the psychiatric emergency unit for agitation, intrusive thoughts with a content frequently related to the infant, ideas of reference, disorganized speech, bizarre behavior, verbal stereotypes, insomnia and anxiety. Due to lack of response to adequate dosage of 2 second-generation antipsychotics, clozapine was initiated up to 250 mg/day. The symptoms remitted in the next 5 days and the patient was discharged. After discharge, at the patient’s request, clozapine was replaced by olanzapine. Visit at 1 year revealed full remission of symptoms. Conclusion Although data is extremely limited, clozapine has been shown to be effective and safe in a severe case of treatment-resistant PPP.
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Affiliation(s)
| | - Petru Ifteni
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania
| | - Ana Dragan
- Clinical Hospital of Psychiatry and Neurology of Brasov, 3rd Department of Clinical Psychiatry, Brasov, Romania
| | | | - Ana Aliana Miron
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania
| | - Lorena Dima
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania
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Perry A, Gordon-Smith K, Jones L, Jones I. Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sci 2021; 11:brainsci11010047. [PMID: 33406713 PMCID: PMC7824357 DOI: 10.3390/brainsci11010047] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.
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Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
- Correspondence:
| | - Katherine Gordon-Smith
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK;
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Ragesh G, Ganjekar S, Thippeswamy H, Desai G, Hamza A, Chandra PS. Feasibility, Acceptability and Usage Patterns of a 24-Hour Mobile Phone Helpline Service for Women Discharged from a Mother-Baby Psychiatry Unit (MBU) in India. Indian J Psychol Med 2020; 42:530-534. [PMID: 33354078 PMCID: PMC7735230 DOI: 10.1177/0253717620954148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For women with perinatal mental illness, phone helplines may be a useful way of accessing help. This study assessed the feasibility, acceptability, limitations, and usage patterns of a helpline service for mothers discharged from a mother-baby psychiatry unit. METHODS Mothers discharged from a mother baby unit during an 18-month period were provided with a helpline number. A social worker answered the calls. Details of the calls, including the reasons and the interventions provided, were recorded. Feasibility and acceptability were assessed by calling all users and nonusers. Satisfaction with the helpline was recorded among users, and reasons for not calling were assessed among nonusers. RESULTS Among 113 mothers, 51 (45%) made 248 calls. Calls were regarding medication, sleep problems, planning pregnancies, symptom exacerbation, appointments, and suicidal ideation. Some calls were related to domestic violence (n = 13, 5.24%), and infant health and breastfeeding (n = 11, 4.44%). Seventy-six (67%, 44 callers and 32 noncallers) were contacted. The majority (41/44) of the callers found it useful: 91% said they got help, and 95% said they would recommend it to others. However, language difficulties (9%) and technical problems (5%) were reported. Among the noncallers, the majority reported having experienced no problem related to mental health or had contacted a doctor. However, of the noncallers, one woman died of suicide, did not have access to a phone, and the family did not choose to call. CONCLUSIONS Helpline phone service appears to be feasible and acceptable and can be adapted in other mother-baby psychiatry units in low and middle-income countries. However, in some women, the nonavailability of a phone may be a limiting factor.
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Affiliation(s)
- G Ragesh
- Dept. of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Govt. Medical College campus, Kozhikode, Kerala, India
| | - Sundarnag Ganjekar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Harish Thippeswamy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Geetha Desai
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ameer Hamza
- Retd Additional Professor, Dept. of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Prabha S Chandra
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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18
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Gilden J, Molenaar NM, Smit AK, Hoogendijk WJG, Rommel AS, Kamperman AM, Bergink V. Mother-to-Infant Bonding in Women with Postpartum Psychosis and Severe Postpartum Depression: A Clinical Cohort Study. J Clin Med 2020; 9:E2291. [PMID: 32707679 PMCID: PMC7408880 DOI: 10.3390/jcm9072291] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Mother-to-infant bonding is important for long-term child development. The aim of this study was to investigate bonding in women admitted to a Mother and Baby Unit with postpartum depression (PD, n = 64) and postpartum psychosis (PP, n = 91). Participants completed the Postpartum Bonding Questionnaire (PBQ), the Edinburgh Postnatal Depression Scale (EPDS) and the Young Mania Rating Scale (YMRS) weekly during admission. At admission, 57.1% of women with PD had impaired bonding, compared to only 17.6% of women with PP (p-value < 0.001). At discharge, only 18.2% of women with PD and 5.9% of women with PP still experienced impaired bonding (p-value = 0.02). There was a strong association between decrease of depressive and manic symptoms and improved bonding over an eight-week admission period. In a small group of women (5.7%) impaired bonding persisted despite being in remission of their psychiatric disorder. The results from our study show that impaired bonding is a more present and evidently severe problem in postpartum depression but not so much in postpartum psychosis. Treatment of depressive symptoms will improve bonding in almost all women, but clinicians should assess if impaired bonding is still present after remission because for a small group special care and treatment focused on bonding might be required.
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Affiliation(s)
- Janneke Gilden
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.M.); (A.K.S.); (W.J.G.H.); (A.M.K.); (V.B.)
| | - Nina M. Molenaar
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.M.); (A.K.S.); (W.J.G.H.); (A.M.K.); (V.B.)
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Anne K. Smit
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.M.); (A.K.S.); (W.J.G.H.); (A.M.K.); (V.B.)
| | - Witte J. G. Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.M.); (A.K.S.); (W.J.G.H.); (A.M.K.); (V.B.)
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Astrid M. Kamperman
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.M.); (A.K.S.); (W.J.G.H.); (A.M.K.); (V.B.)
- Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.M.); (A.K.S.); (W.J.G.H.); (A.M.K.); (V.B.)
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
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Rönnqvist I, Brus O, Hammar Å, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A. Rehospitalization of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Control Group. J ECT 2019; 35:264-271. [PMID: 31764450 PMCID: PMC6903363 DOI: 10.1097/yct.0000000000000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is used in some cases of postpartum depression (PPD) and postpartum psychosis (PPP). The risk of relapse for PPD and PPP after ECT is unknown. This study compared the relapse rate after ECT between women who had been treated for PPD and/or PPP and women who had been treated for depression and/or psychosis outside the postpartum period. METHODS The Swedish National Quality Register for ECT and the Swedish National Patient Register were used to identify women with PPD and/or PPP who had been treated with ECT within 6 months after delivery. For each case, a control (treated with ECT but not postpartum) patient was also selected. A Kaplan-Meier estimator was used to calculate the relapse rate (defined as rehospitalization or suicide) after ECT. Cox regression was used to identify variables associated with relapse. RESULTS A total of 180 patients were included in each group. The proportions of patients who suffered relapse after 6 months, 1 year, and 2 years were 28%, 31%, and 40% for the postpartum group and 39%, 50%, and 55% for the nonpostpartum group. Treatment with benzodiazepines, several previous psychiatric admissions, and the absence of improvement after ECT were associated with relapse. CONCLUSIONS The risk of relapse after ECT is lower for patients with PPD and/or PPP than for patients outside the postpartum period, but the risk is nonetheless substantial in both groups.
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Affiliation(s)
| | - Ole Brus
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg
| | - Johan Lundberg
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping
- Department of Psychiatry, Region Östergötland, Linköping, Sweden
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Korteland TW, Koorengevel KM, Poslawsky IE, van Meijel B. Nursing interventions for patients with postpartum psychosis hospitalized in a psychiatric mother-baby unit: A qualitative study. J Psychiatr Ment Health Nurs 2019; 26:254-264. [PMID: 31250503 DOI: 10.1111/jpm.12542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/31/2019] [Accepted: 06/24/2019] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT If women suffer from postpartum psychosis, treatment in a specialist facility like a psychiatric mother-baby unit is recommended and should focus on the maternal health, mother-baby outcomes and the care for the next of kin. The role of mental health nurses on a mother-baby unit is essential but challenging, given the complex problems and care needs of the patient, the baby and family members. To date, very little evidence about effective nursing interventions for patients with postpartum psychosis is available. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE This paper systematically describes nursing interventions and their rationale for patients with postpartum psychosis admitted to a specialized mother-baby unit. Given the limited scientific evidence for effective nursing interventions for patients with postpartum psychosis, knowledge was obtained from a best-practice setting (i.e., a specialized mother-baby unit), thus providing a basis for the systematic development of nursing interventions to be tested on effectiveness in future studies. IMPLICATIONS FOR MENTAL HEALTH NURSING Mental health nurses play an essential role in the multidisciplinary treatment team in providing information on the patient's personal functioning and her ability to take care for the baby, in order to determine the appropriate amount of guidance and protection, in order to prevent harm and promote recovery. To provide integrated and personalized nursing care, mental health nurses should tailor their interventions to the needs of the patient, the baby and the next of kin, adapted to the successive stages of treatment. Abstract Introduction Postpartum psychosis is one of the severest psychiatric disorders to occur in the postpartum period. If it requires a woman's admission, a psychiatric mother-baby unit is recommended, where care will focus on the mother's health, the mother-baby dyad and their next of kin. To date, few studies have examined nursing interventions for patients with postpartum psychosis. Aim Identifying nursing interventions used at a psychiatric mother-baby unit, when a patient is hospitalized with postpartum psychosis. Method A qualitative design using thematic analysis. Data were collected using semi-structured interviews (N = 13) with expert nurses working at such a unit. Results The analysis identified three themes: (a) treatment of the mental disorder, which involves interventions to improve the mother's mental and physical well-being; (b) care for the mother-baby dyad, which involves interventions intended to promote safe interactions between mother and baby; and (c) care for the partner, which involves interventions to improve the partner's well-being. Discussion Overall, within each of these themes, nurses described the urgency to tailor interventions to the needs of the patient, baby and partner. Implications to practice Our comprehensive description of interventions can be used for the improvement of nursing care for patients hospitalized with postpartum psychosis.
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Affiliation(s)
- Tim W Korteland
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Irina E Poslawsky
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Nursing Science, Programme in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC (VUmc), Amsterdam, The Netherlands.,GGZ-VS Masters of Advanced Nursing Practice, Utrecht, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands
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21
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Abstract
BACKGROUND Steroid sulfatase (STS) cleaves sulfate groups from steroid hormones; its expression/activity increases in late pregnancy and into the postpartum period. STS-deficient human and mouse mothers display elevated psychopathology and abnormal behaviour respectively; in mice, these effects can be partially normalised by antipsychotic (ziprasidone) administration. METHODOLOGY We compared brain gene expression in new mouse mothers administered the STS inhibitor 667-Coumate, or vehicle; significant changes were followed-up with pathway analysis and quantitative polymerase chain reaction (qPCR). Finally, the effects of combined 667-Coumate and ziprasidone administration on expression of the most robustly differentially-expressed genes were examined. RESULTS Surprisingly, no between-group gene expression changes were detected at a False Discovery Rate (FDR)-corrected p<0.1. 1,081 unique expression changes were detected at p<0.05, two top hits were verified by qPCR, and pathway analysis indicated enrichment of genes involved in olfactory transduction. The expression of Stoml3 and Cyp2g1 was unaffected by ziprasidone administration. CONCLUSIONS Postpartum behavioural abnormalities in STS-deficient mothers are likely to be the culmination of many small gene expression changes. Our data are consistent with the idea that olfactory function is key to maternal behaviour in mice, and suggest that aberrant expression of olfactory system genes may underlie abnormal maternal behaviour in STS-deficient women.
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Affiliation(s)
- Trevor Humby
- School of Psychology, Cardiff University, Cardiff CF10 3AT, Cardiff, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, CardiffCF24 4HQ, UK
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, CardiffCF24 4HQ, UK
| | - William Davies
- School of Psychology, Cardiff University, Cardiff CF10 3AT, Cardiff, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, CardiffCF24 4HQ, UK
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, CardiffCF24 4HQ, UK
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22
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Naito T, Chin J, Lin J, Shah PJ, Lomiguen CM. Postpartum psychosis in a non-native language-speaking patient: A perspective on language barriers and cultural competency. Gen Psychiatr 2019; 32:e100077. [PMID: 31360910 PMCID: PMC6629379 DOI: 10.1136/gpsych-2019-100077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/05/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
Postpartum psychosis is a condition characterised by rapid onset of psychotic symptoms several weeks after childbirth. Outside of its timing and descriptions of psychotic features, minimal research exists due to its relative rarity (1 to 2 per 1000 births in the USA), with greater emphasis on postpartum sadness and depression. With the existing literature, cultural differences and language barriers previously have not been taken into consideration as there are no documented cases of postpartum psychosis in a non–English-speaking patient. Correctly differentiating postpartum psychosis from other postpartum psychiatric disorders requires adeptly evaluating for the presence of psychotic symptoms with in-depth history taking. Here, we present a case of postpartum psychosis in a Japanese-speaking only patient, with an associated clinical course and culturally appropriate approach to treatment. A review of postpartum psychosis and language/cultural considerations are also discussed, with attention on the Japanese concept of ‘Satogaeri bunben’.
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Affiliation(s)
- Tatsuhiko Naito
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Justin Chin
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Jun Lin
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Pritesh J Shah
- Psychiatry, Holy Name Medical Center, Teaneck, New Jersey, USA
| | - Christine M Lomiguen
- Basic Sciences, Lake Erie College of Osteopathic Medicine, Erie, Pennslyvannia, USA
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23
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Abstract
OBJECTIVES To describe characteristics and treatments of mother-baby dyads affected by postpartum psychosis admitted to a specialist mother-baby inpatient psychiatric unit in Australia. METHODS A retrospective review of medical records for all mothers with postpartum psychosis and their babies admitted to a mother-baby unit over a 5-year period was conducted. RESULTS A total of 25 dyads met the study criteria. Affected women were found to be severely ill with a high rate of involuntary status (64%). They waited an average 4.7 days for a bed in the mother-baby unit. All received an atypical antipsychotic, with 16% receiving lithium augmentation. Infants were found to have generally normative growth and development, with relationship concerns noted in 5. A total of 36% of the cohort maintained some breastfeeding, and all had their infants in their care at discharge. CONCLUSIONS The mother-baby unit enabled severely ill women to remain with their infants during treatment. While a minority of infants showed developmental concerns, appropriate development was noted in most. Future efforts should focus on determining the most effective treatments and further defining the risks and benefits for infants in mother-baby units.
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Affiliation(s)
- Rebecca Hill
- Consultant Psychiatrist, Perinatal and Infant Mental Health Services, Women's and Children's Health Network, North Adelaide, SA, and; Clinical Senior Lecturer, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Daphne Law
- Consultant Child and Adolescent Psychiatrist, Child and Adolescent Mental Health Services, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Chris Yelland
- Psychologist, Perinatal and Infant Mental Health Services, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Anne Sved Williams
- Director and Medical Unit Head, Perinatal and Infant Mental Health Services, Women's and Children's Health Network, North Adelaide, SA, and; Clinical Senior Lecturer, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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24
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Davies W. SULFATION PATHWAYS: The steroid sulfate axis and its relationship to maternal behaviour and mental health. J Mol Endocrinol 2018; 61:T199-T210. [PMID: 29440314 DOI: 10.1530/jme-17-0219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022]
Abstract
Steroid hormones can exist in functionally dissociable sulfated and non-sulfated (free) forms and can exert profound effects on numerous aspects of mammalian physiology; the ratio of free-to-sulfated steroids is governed by the antagonistic actions of steroid sulfatase (STS) and sulfotransferase (SULT) enzymes. Here, I examine evidence from human and animal model studies, which suggests that STS and its major substrate (dehydroepiandrosterone sulfate, DHEAS) and product (DHEA) can influence brain function, behaviour and mental health, before summarising how the activity of this axis varies throughout mammalian pregnancy and the postpartum period. I then consider how the steroid sulfate axis might impact upon normal maternal behaviour and how its dysfunction might contribute towards risk of postpartum psychiatric illness. Understanding the biological substrates underlying normal and abnormal maternal behaviour will be important for maximising the wellbeing of new mothers and their offspring.
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Affiliation(s)
- William Davies
- School of PsychologyCardiff University, Cardiff, UK
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical NeurosciencesSchool of Medicine, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research InstituteCardiff University, Cardiff, UK
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Kamperman AM, Veldman-Hoek MJ, Wesseloo R, Robertson Blackmore E, Bergink V. Phenotypical characteristics of postpartum psychosis: A clinical cohort study. Bipolar Disord 2017; 19:450-457. [PMID: 28699248 DOI: 10.1111/bdi.12523] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/12/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Postpartum psychosis (PP) is known for its clear onset but its phenotype has never been clearly described in a cohort. The aim of this study was to describe PP symptomatology, and to identify subgroups of patients based on symptom profiles. METHODS We prospectively assessed a wide range of symptoms in cases of PP in a cohort of women (N=130) admitted to the Mother-Baby inpatient unit. Using a person-centered analytic approach, we distinguished mutually exclusive subgroups of women. Subgroups were related to demographic and clinical characteristics. RESULTS The most prevalent symptoms of PP were irritability (73%), abnormal thought content (72%), and anxiety (71%). Suicidal and infanticidal ideation was present in 19% and 8% of patients, respectively. Delusions and hallucinations often had a negative content. Latent class analysis revealed three symptom profiles, a manic (34%), depressive (41%) and atypical (25%) profile, respectively. The manic profile is characterized by manic symptoms and agitation, the depressive profile by depressive and anxiety symptoms, and the atypical profile by disturbance of consciousness and disorientation. In women with a depressive profile, treatment was started 2 weeks later (P=.049), and more often voluntarily, than in manic and atypical women (P=.037). CONCLUSIONS We distinguished subgroups of PP patients with a manic, depressive, and atypical profile. Disturbance of consciousness, disorientation, and depersonalization/derealization were less prevalent than previously suggested in the literature. Instead, the depressive profile was the most prevalent, but the depressive profile can easily remain undetected, which could lead to treatment delay and risk of suicide/infanticide. Within the manic profile, irritability was highly prevalent and occurred more often than elevated mood.
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Affiliation(s)
- Astrid M Kamperman
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marian J Veldman-Hoek
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.,Antes Center for Mental Health Care, Rotterdam, The Netherlands
| | - Richard Wesseloo
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Veerle Bergink
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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Meltzer-Brody S, Maegbaek ML, Medland SE, Miller WC, Sullivan P, Munk-Olsen T. Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women. Psychol Med 2017; 47:1427-1441. [PMID: 28112056 PMCID: PMC5429203 DOI: 10.1017/s0033291716003020] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Childbirth is a potent trigger for the onset of psychiatric illness in women including postpartum depression (PPD) and postpartum psychosis (PP). Medical complications occurring during pregnancy and/or childbirth have been linked to postpartum psychiatric illness and sociodemographic factors. We evaluated if pregnancy and obstetrical predictors have similar effects on different types of postpartum psychiatric disorders. METHOD A population-based cohort study using Danish registers was conducted in 392 458 primiparous women with a singleton delivery between 1995 and 2012 and no previous psychiatric history. The main outcome was first-onset postpartum psychiatric episodes. Incidence rate ratios (IRRs) were calculated for any psychiatric contact in four quarters for the first year postpartum. RESULTS PPD and postpartum acute stress reactions were associated with pregnancy and obstetrical complications. For PPD, hyperemesis gravidarum [IRR 2.69, 95% confidence interval (CI) 1.93-3.73], gestational hypertension (IRR 1.84, 95% CI 1.33-2.55), pre-eclampsia (IRR 1.45, 95% CI 1.14-1.84) and Cesarean section (C-section) (IRR 1.32, 95% CI 1.13-1.53) were associated with increased risk. For postpartum acute stress, hyperemesis gravidarum (IRR 1.93, 95% CI 1.38-2.71), preterm birth (IRR 1.51, 95% CI 1.30-1.75), gestational diabetes (IRR 1.42, 95% CI 1.03-1.97) and C-section (IRR 1.36, 95% CI 1.20-1.55) were associated with increased risk. In contrast, risk of PP was not associated with pregnancy or obstetrical complications. CONCLUSIONS Pregnancy and obstetrical complications can increase the risk for PPD and acute stress reactions but not PP. Identification of postpartum women requiring secondary care is needed to develop targeted approaches for screening and treatment. Future work should focus on understanding the contributions of psychological stressors and underlying biology on the development of postpartum psychiatric illness.
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Affiliation(s)
- S. Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. L. Maegbaek
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - S. E. Medland
- Quantitative Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - W. C. Miller
- Department of Epidemiology, The Ohio State University, Columbus, OH, USA
| | - P. Sullivan
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - T. Munk-Olsen
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
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Plunkett C, Peters S, Wieck A, Wittkowski A. A qualitative investigation in the role of the baby in recovery from postpartum psychosis. Clin Psychol Psychother 2017; 24:1099-1108. [PMID: 28138996 DOI: 10.1002/cpp.2074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/06/2016] [Accepted: 12/29/2016] [Indexed: 11/07/2022]
Abstract
Psychosis after childbirth is a rare but severe type of mental health difficulty experienced by perinatal women. Research has explored mothers' experiences of onset and recovery from psychosis after childbirth. This study explored the role of the baby in 12 mothers' experiences of recovery. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery from psychosis after childbirth. Findings revealed that the baby was central to recovery, experienced by mothers as both helpful and unhelpful. The baby interacted with the mother, increasing self-efficacy, and reducing emotional distress. Findings also showed that the baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self-care. The findings of the study add to the existing evidence based on recovery from psychosis after childbirth. The research and clinical implications of these findings are discussed with reference to the existing literature. KEY PRACTITIONER MESSAGE The baby has an important role in recovery from psychosis after childbirth. The baby can be perceived by mothers to both hinder and help their recovery. Interacting with the baby can be helpful for the mothers' recovery by improving their self-efficacy and reducing emotional distress. Specialist interventions offered by a mother and baby unit can provide practical support that facilitates mother-baby interactions, which helps move women forward in the recovery process.
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Affiliation(s)
| | - Sarah Peters
- School of Health Sciences, University of Manchester, UK
| | | | - Anja Wittkowski
- School of Health Sciences, University of Manchester, UK.,Manchester Mental Health and Social Care Trust, UK
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Vikström J, Josefsson A, Hammar M, Bladh M, Sydsjö G. Risk of postpartum psychosis after IVF treatment: a nationwide case-control study. Hum Reprod 2016; 32:139-146. [PMID: 27927846 DOI: 10.1093/humrep/dew302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is the risk of postpartum psychosis (PPP) increased in women who give birth after IVF treatment compared to after spontaneous conception? SUMMARY ANSWER The risk of PPP is not higher in the group of women who give birth after IVF treatment compared with women who give birth after spontaneous conception. WHAT IS KNOWN ALREADY Women who conceive using IVF treatment can experience higher levels of pregnancy-specific distress and are at increased risk of pre-eclampsia, an immune-related condition which in turn has been linked to PPP, as well as other pregnancy and delivery complications, which also serve as PPP risk factors. It is not known whether the risk of PPP is increased in women who have conceived using IVF treatment. STUDY DESIGN, SIZE, DURATION A nationwide, register-based, case-control study of all primiparous women who had given birth after IVF treatment between 1988 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Information about 10 412 women was collected from the Swedish IVF register. A control group of women who had given birth after spontaneous conception was selected from the Swedish Medical Birth Register (n = 18 624). PPP diagnoses, identified using ICD-10 diagnostic codes F20-31 and F531 the first year postpartum, were collected from the National Patient Register. Associations between PPP and IVF/spontaneous conception were evaluated using chi-square tests and logistic regression analyses while controlling for known risk factors of PPP. MAIN RESULTS AND THE ROLE OF CHANCE There were no differences in PPP prevalence between the IVF group and the control group (0.3%, n = 29 versus 0.4%, n = 77) in the chi-square analysis (P = 0.169) or the multiple logistic regression analyses (P = 0.646; odds ratio (OR): 1.178; 95% CI: 586-2.365). No associations between pregnancy or delivery complications and PPP were found. A history of any psychiatric disorder (P < 0.001; OR = 40.7; 95% CI = 23.9-69.5), or specifically a psychotic (P < 0.001; OR = 324.1; 95% CI = 131.3-800.0), bipolar (P < 0.001; OR = 516.1; 95% CI = 264.3-1008.1), depressive (P < 0.001; OR = 27.5; 95% CI = 16.2-46.5), anxiety (P < 0.001; OR = 12.9; 95% CI = 7.4-22.6) or personality disorder (P < 0.001; OR = 27.3; CI = 11.8-63.0), all significantly increased the risk of PPP. LIMITATIONS REASONS FOR CAUTION PPP is a rare condition, hence the number of individuals was small. Since all women for whom information was available from all registers were included, it was not possible to further increase the power of the study using this design. WIDER IMPLICATIONS OF THE FINDINGS Since this study is the first to examine risk of PPP after IVF treatment, more studies are needed to verify these results. The generalizability is restricted to primiparous women in western countries. This study confirms the results of previous studies in showing a history of mental illness to be the major risk factor for PPP. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Josefin Vikström
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Boddy R, Gordon C, MacCallum F, McGuinness M. Men's experiences of having a partner who requires Mother and Baby Unit admission for first episode postpartum psychosis. J Adv Nurs 2016; 73:399-409. [PMID: 27533096 DOI: 10.1111/jan.13110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to explore the experiences of men during their partner's admission to a Mother and Baby Unit for first episode postpartum psychosis. BACKGROUND Postpartum psychosis can be life-changing for women, however little is known about the impact on their partners or their partners' needs. DESIGN An Interpretative Phenomenological Analysis approach was used to analyse interview transcripts. METHODS Semi-structured interviews were conducted with seven participants. Interviews were conducted in 2014-2015. FINDINGS Two main themes were identified: 'What the f*** is going on?' and 'Time to figure out how your family works'. Partners experienced shock and confusion during postpartum psychosis onset. Most felt hospital admission was beneficial, although there were barriers to accessing help and involvement in their partner's care. A process of understanding changes to roles, relationships and family identity was described. Loss was a common experience, with a potentially lasting impact. CONCLUSIONS Men reported a range of challenging and positive experiences associated with their partner's postpartum psychosis. Improvements are needed in awareness of postpartum psychosis, access to appropriate services and support of partners.
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Affiliation(s)
- Rebecca Boddy
- School of Psychological, Social and Behavioural Sciences, Coventry University, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | - Carolyn Gordon
- School of Psychological, Social and Behavioural Sciences, Coventry University, UK
| | - Fiona MacCallum
- Department of Psychology, University of Warwick, Coventry, UK
| | - Mary McGuinness
- Birmingham and Solihull Mental Health NHS Foundation Trust, Perinatal Mental Health Service, UK
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30
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Abstract
The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response.
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Affiliation(s)
- Samantha Meltzer-Brody
- UNC Center for Women's Mood Disorder, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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31
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Bergink V, Laursen TM, Johannsen BMW, Kushner SA, Meltzer-Brody S, Munk-Olsen T. Pre-eclampsia and first-onset postpartum psychiatric episodes: a Danish population-based cohort study. Psychol Med 2015; 45:3481-3489. [PMID: 26243040 PMCID: PMC4806793 DOI: 10.1017/s0033291715001385] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent evidence suggests that postpartum psychiatric episodes may share similar etiological mechanisms with immune-related disorders. Pre-eclampsia is one of the most prevalent immune-related disorders of pregnancy. Multiple clinical features are shared between pre-eclampsia and postpartum psychiatric disorders, most prominently a strong link to first pregnancies. Therefore, we aimed to study if pre-eclampsia is a risk factor for first-onset postpartum psychiatric episodes. METHOD We conducted a cohort study using the Danish population registry, with a total of 400 717 primiparous women with a singleton delivery between 1995 and 2011. First-lifetime childbirth was the main exposure variable and the outcome of interest was first-onset postpartum psychiatric episodes. The main outcome measures were monthly incidence rate ratios (IRRs), with the period 11-12 months after birth as the reference category. Adjustments were made for age, calendar period, reproductive history, and perinatal maternal health including somatic and obstetric co-morbidity. RESULTS Primiparous women were at particularly high risk of first-onset psychiatric episodes during the first month postpartum [IRR 2.93, 95% confidence interval (CI) 2.53-3.40] and pre-eclampsia added to that risk (IRR 4.21, 95% CI 2.89-6.13). Having both pre-eclampsia and a somatic co-morbidity resulted in the highest risk of psychiatric episodes during the 3-month period after childbirth (IRR 4.81, 95% CI 2.72-8.50). CONCLUSIONS We confirmed an association between pre-eclampsia and postpartum psychiatric episodes. The possible explanations for this association, which are not mutually exclusive, include the psychological impact of a serious medical condition such as pre-eclampsia and the neurobiological impact of pre-eclampsia-related vascular pathology and inflammation.
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Affiliation(s)
- V. Bergink
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
- Department of Psychiatry, Erasmus Medical Center, ’s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - T. M. Laursen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
- CIRRAU, Centre for Integrated Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
| | - B. M. W. Johannsen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
| | - S. A. Kushner
- Department of Psychiatry, Erasmus Medical Center, ’s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - S. Meltzer-Brody
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC 27599, USA
| | - T. Munk-Olsen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
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Thippeswamy H, Dahale A, Desai G, Chandra PS. What is in a name? Causative explanatory models of postpartum psychosis among patients and caregivers in India. Int J Soc Psychiatry 2015; 61:818-23. [PMID: 26238989 DOI: 10.1177/0020764015597016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Explanatory models (EMs) influence decision-making related to treatment and compliance. There is little knowledge about belief systems related to postpartum psychosis in different cultures. AIMS To study EMs of illness among women with postpartum psychosis and their family members in India. METHOD A total of 123 women with postpartum psychosis and their caregivers were assessed to understand their beliefs regarding causes of postpartum psychosis using Short Explanatory Model Interview (SEMI). Local names were listed and emerging themes were analysed. RESULTS Respondents often held more than one EM and only one-third held a biomedical EM. Other common models included stressors unique to childbirth, marital stress and supernatural causes. Local names reflected the underlying models. CONCLUSION Non-biomedical EMs are common in women with postpartum psychosis. Cultural and social factors unique to childbirth appear to influence these models. There is a need to enhance awareness and knowledge about this serious disorder in the community.
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Affiliation(s)
- Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ajit Dahale
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Di Florio A, Morgan H, Jones L, Forty L, Gordon-Smith K, Craddock N, Jones I. Smoking and postpartum psychosis. Bipolar Disord 2015; 17:572-3. [PMID: 26241192 DOI: 10.1111/bdi.12314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/19/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Arianna Di Florio
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly Morgan
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lisa Jones
- Department of Psychiatry, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Liz Forty
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Katherine Gordon-Smith
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,Department of Psychiatry, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Nick Craddock
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Ian Jones
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Abstract
Postpartum period is demanding period characterized by overwhelming biological, physical, social, and emotional changes. It requires significant personal and interpersonal adaptation, especially in case of primigravida. Pregnant women and their families have lots of aspirations from the postpartum period, which is colored by the joyful arrival of a new baby. Unfortunately, women in the postpartum period can be vulnerable to a range of psychiatric disorders like postpartum blues, depression, and psychosis. Perinatal mental illness is largely under-diagnosed and can have far reaching ramifications for both the mother and the infant. Early screening, diagnosis, and management are very important and must be considered as mandatory part of postpartum care.
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Affiliation(s)
- Shashi Rai
- SAMBAL Drug De-addiction and Psychiatric Centre, Lucknow, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Indira Sharma
- Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Chandra PS, Desai G, Reddy D, Thippeswamy H, Saraf G. The establishment of a mother-baby inpatient psychiatry unit in India: Adaptation of a Western model to meet local cultural and resource needs. Indian J Psychiatry 2015; 57:290-4. [PMID: 26600584 PMCID: PMC4623649 DOI: 10.4103/0019-5545.166621] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel. MATERIALS AND METHODS The first dedicated inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants. We describe the unique challenges faced in the unit, characteristics of this patient population and clinical outcomes. RESULTS Two hundred and thirty-seven mother-infant pairs were admitted from July 2009 to September 2013. Bipolar disorder and acute polymorphic psychosis were the most frequent primary diagnosis (36% and 34.5%). Fifteen percent of the women had catatonic symptoms. Suicide risk was present in 36 (17%) mothers and risk to the infant by mothers in 32 (16%). Mother-infant bonding problems were seen in 98 (41%) mothers and total breastfeeding disruption in 87 (36.7%) mothers. Eighty-seven infants (37%) needed an emergency pediatric referral. Ongoing domestic violence was reported by 42 (18%). The majority of the mother infant dyads stayed for <4 weeks and were noted to have improved at discharge. However, 12 (6%) mothers had readmissions during the study period of 4 years. Disrupted breastfeeding was restituted in 75 of 87 (86%), mother infant dyads and mother infant bonding were normal in all except ten mothers at discharge. CONCLUSIONS Starting an MBU in a low resource setting is feasible and is associated with good clinical outcomes. Addressing risks, poor infant health, breastfeeding disruption, mother infant bonding and ongoing domestic violence are the challenges during the process.
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Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dharma Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gayatri Saraf
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Abstract
A twenty-one-year old primigravida presented two weeks postpartum with new onset of behavioral alteration and irrelevant talking without fever, headache, or seizures. Magnetic resonance imaging (MRI) of brain showed a lesion with diffusion restriction in splenium of corpus callosum. A possibility of postpartum psychosis was considered after ruling out various etiologies for splenium hyperintense lesion. Near complete resolution of symptoms was noted after initiation of antipsychotic medications. Literature has described multiple etiologies for lesions involving splenium of corpus callosum on brain imaging. We present this case as a unique clinical presentation of splenial pathology in the form of postpartum psychosis.
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Affiliation(s)
- Shankar C Udaya
- Department of Neurology, Narayana Institute of Neurosciences, Narayana Health City, Bangalore, Karnataka, India
| | - Bhumir N Chauhan
- Department of Neurology, Narayana Institute of Neurosciences, Narayana Health City, Bangalore, Karnataka, India
| | - Vivek J Philip
- Department of Neurology, Narayana Institute of Neurosciences, Narayana Health City, Bangalore, Karnataka, India
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Reddy PD, Desai G, Hamza A, Karthik S, Ananthanpillai ST, Chandra PS. Enhancing Mother Infant Interactions through Video Feedback Enabled Interventions in Women with Schizophrenia: A Single Subject Research Design Study. Indian J Psychol Med 2014; 36:373-7. [PMID: 25336768 PMCID: PMC4201788 DOI: 10.4103/0253-7176.140702] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It has been shown that mother infant interactions are often impaired in mothers with schizophrenia. Contributory factors include psychotic symptoms, negative symptoms and surrogate parenting by others. AIM This study describes the effectiveness of video feedback in enhancing mother-infant interaction in mothers with schizophrenia who have impaired interaction with their infant. MATERIALS AND METHODS Two women with schizophrenia who were admitted for persistent psychotic symptoms and poor mothering skills, participated in the intervention. Pre intervention parenting assessment was done using video recording of mother infant interaction. Six sessions of mothering intervention were provided using video feedback and a repeat recording was done. Pre-and post-intervention videos were subsequently rated in a blind fashion by an independent expert in perinatal psychiatry using the pediatric infant parent exam (PIPE) scale. RESULTS Pre and post intervention comparison of PIPE scores indicating significant improvement in several areas of mothering. CONCLUSIONS Video feedback is a simple and inexpensive tool which can be used for improving mothering skills among mothers with postpartum psychosis or schizophrenia even in low resource settings.
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Affiliation(s)
- Pashapu Dharma Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Geehta Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ameer Hamza
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sheshachala Karthik
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Russell T, Wightman AS, Cannon C, Hurst D, Walker L, Heath NN, Evans J, Hunter K, Osborne J. Abstracts of the 2014 AWHONN Annual Convention, June 14-18, 2014, Orlando, Florida. J Obstet Gynecol Neonatal Nurs 2014; 43 Suppl 1:S1-S102. [PMID: 24931718 DOI: 10.1111/1552-6909.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Engqvist I, Nilsson K. The Recovery Process of Postpartum Psychosis from Both the Woman's and Next of Kin's Perspective - An Interview Study in Sweden. Open Nurs J 2014; 8:8-16. [PMID: 24660040 PMCID: PMC3960751 DOI: 10.2174/1874434601408010008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/11/2014] [Accepted: 01/13/2014] [Indexed: 01/27/2023] Open
Abstract
Objectives: The most serious type of psychiatric disorder in connection with childbirth is postpartum
psychosis. With this disorder occasionally follows emotional rejection of the infant which has serious long term effect on
mother and child. The aim of this study was to explore the experiences of the recovery process of postpartum psychosis
from the women, from the partners of the women, and their next of kin. Methods: Interviews were conducted with seven women, who had previously suffered postpartum psychosis, and six of
their next of kin. The interviews were transcribed verbatim and analysed using content analysis. Results: Two categories emerged: the recovery process and the circumstances of the support provided. The women and
their next of kin spoke about the turning point in the illness, their own personal as well as their social recovery, the
importance of support not only from relatives and friends, but also from professionals, and the use of medication.
However, the key to recovery was an internal decision by the women themselves. Conclusion: Conclusion is that the recovery from this severe mental disorder requires hard work and the key to their
recovery was the decision made by the women. This disorder causes a mental darkness to descend, but at the start of the
recovery a dim light shines in the dark tunnel. The nursing staff must be made aware that good sleep is important for the
psychiatric treatment and that recovery may take a long time. The nurse needs to provide hope and encouragement, as
well as help the woman to recognise the strength that exists within her. To reduce the risk of a recurrence of the disorder,
the staff needs to offer follow up visits.
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Affiliation(s)
- I Engqvist
- School of Life Science, University of Skövde, Sweden ; Skaraborg Hospitals, Falköping, Sweden
| | - K Nilsson
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Bergink V, Gibney SM, Drexhage HA. Autoimmunity, inflammation, and psychosis: a search for peripheral markers. Biol Psychiatry 2014; 75:324-31. [PMID: 24286760 DOI: 10.1016/j.biopsych.2013.09.037] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/08/2013] [Accepted: 09/27/2013] [Indexed: 02/06/2023]
Abstract
Accumulating evidence supports the view that deregulation of the immune system represents an important vulnerability factor for psychosis. In a subgroup of psychotic patients, the high comorbidity with autoimmune and chronic inflammatory conditions suggests a common underlying immune abnormality leading to both conditions. The reviewed data of affective and nonaffective psychosis show that if immune biomarkers exist for such immune abnormality, they may be found in raised macrophage/monocyte inflammatory activation patterns (monocytosis, high-inflammatory gene expression, raised glucocorticoid receptor β/glucocorticoid receptor α ratio, and high levels of proinflammatory and anti-inflammatory monocyte/macrophage derived cytokines in serum/plasma), reduced T cell numbers/proliferation, and TH1 skewing. This activation of the inflammatory response system may be suggestive for microglia activation, as these cells are the macrophages of the brain. Indeed, there is some evidence of activation of the microglia as detected in positron emission tomography scans and in histopathology, and it is assumed that this activation disturbs the development and function of neuronal circuits in the brain. Further, animal models of psychotic conditions (maternal stress and inflammation paradigms) suggest that such monocyte/microglia activation could be seen as the result of a combination of genetic predisposition and an immune-mediated two-hit model. Infection but also environmental stressors during gestation/early life activate microglia, perturbing neuronal development, thereby setting the stage for vulnerability for later psychotic disorders. A second hit, such as endocrine changes, stress, or infection, could further activate microglia, leading to functional abnormalities of the neuronal circuitry in the brain and psychosis.
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Affiliation(s)
- Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands.
| | - Sinead M Gibney
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Hemmo A Drexhage
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
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Abstract
BACKGROUND Psychosis following childbirth affects 1-2 mothers per 1000 deliveries. Onset is rapid and functioning is severely affected. Although prognosis in terms of symptom remission is generally good, long-term disability can persist. The study's aim was to develop a theoretical understanding of recovery from psychosis following childbirth. METHODS Semi-structured interviews were conducted with 12 women with experience of psychosis following childbirth. Interview transcripts were analysed using grounded theory methodology. RESULTS A theory of four superordinate themes was developed from the data, including: (i) the process of recovery; (ii) evolving an understanding; (iii) strategies for recovery; and (iv) sociocultural context. The process of recovery and women's understanding of their experience were conceptualised as parallel processes, which informed one another. Women found that a diagnosis facilitated their use of particular strategies. CONCLUSIONS This study highlighted a complex and ongoing process of recovery from psychosis following childbirth. Sensitivity to a woman's position in the process of recovery has the potential to facilitate professionals in assessing readiness for different interventions which will be likely to result in women feeling more understood, accepted and supported.
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Affiliation(s)
- Laura McGrath
- School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Sarah Peters
- School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Angelika Wieck
- Manchester Mental Health and Social Care Trust, Wythenshawe Hospital, Manchester, UK
| | - Anja Wittkowski
- School of Psychological Sciences, the University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK.
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Abstract
Perinatal mental illness is a significant complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder. Perinatal depression and anxiety are common, with prevalence rates for major and minor depression up to almost 20% during pregnancy and the first 3 months postpartum. Postpartum blues are a common but lesser manifestation of postpartum affective disturbance. Perinatal psychiatric disorders impair a woman's function and are associated with suboptimal development of her offspring. Risk factors include past history of depression, anxiety, or bipolar disorder, as well psychosocial factors, such as ongoing conflict with the partner, poor social support, and ongoing stressful life events. Early symptoms of depression, anxiety, and mania can be detected through screening in pregnancy and the postpartum period. Early detection and effective management of perinatal psychiatric disorders are critical for the welfare of women and their offspring.
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Affiliation(s)
- Michael W O'Hara
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA.
| | - Katherine L Wisner
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
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Ganjekar S, Desai G, Chandra PS. A comparative study of psychopathology, symptom severity, and short-term outcome of postpartum and nonpostpartum mania. Bipolar Disord 2013; 15:713-8. [PMID: 23635018 DOI: 10.1111/bdi.12076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Most studies acknowledge that postpartum psychosis is a variant of bipolar disorder with certain unique clinical features. There have been several descriptions of similarities and differences between postpartum psychosis and postpartum mania to support this conclusion. However, not many studies have compared postpartum-onset and nonpostpartum-onset mania. This study compared short-term outcome, clinical features, and severity of symptoms between these two groups. METHODS Two groups of women (n = 30 each) matching the study criteria were recruited from psychiatric inpatient units in India during the period from April 2007 to August 2008. They had been systematically assessed for psychiatric symptoms and symptom severity using the Comprehensive Psychopathology Rating Scale (CPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), and Global Assessment of Functioning Scale (GAF). To evaluate short-term outcome, all assessments were conducted within a week of admission and were repeated at six weeks. RESULTS Women with postpartum-onset mania had higher scores on the HDRS, indicating more depressive symptoms. The score on the anxiety factor of the HDRS was also higher in the postpartum group. Based on CPRS ratings, perplexity, muscle tension, worrying, inner tension, lability of mood, lassitude, and disorientation were more common in the postpartum group, while typical manic symptoms were more common in the nonpostpartum group. Duration of hospital stay and short-term outcome were, however, similar in the two groups. CONCLUSIONS Symptoms of depression and anxiety are more common and more severe in mania of postpartum onset and typical manic symptoms are fewer. However, six-week outcomes appear similar to those of nonpostpartum mania.
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Blackmore ER, Rubinow DR, O’Connor TG, Liu X, Tang W, Craddock N, Jones I. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord 2013; 15:394-404. [PMID: 23651079 PMCID: PMC3740048 DOI: 10.1111/bdi.12071] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Women who experience postpartum psychosis (PP) seek guidance on further pregnancies and risk of illness; however, empirical data are limited. This study describes reproductive and mental health outcomes in women diagnosed with PP and examines clinical risk factors as predictors of further illness. METHODS A retrospective cohort design was used; 116 women who experienced episodes of mania or depression with psychotic features within six weeks of childbirth were recruited. All subjects underwent clinical diagnostic interviews and medical case notes were reviewed. RESULTS Only 33% of women had an antecedent history, of which 34% had bipolar disorder and 55% unipolar depression. Only 58% of those with PP in their first pregnancy had a subsequent pregnancy, and 18% of marriages ended following the PP episode. Clinical presentation at the time of initial episode did not influence the timing of the onset of symptoms, treatment, or recovery. Although 86% of patients received treatment within 30 days of onset, 26% of women reported ongoing symptoms at a year after delivery. The recurrence rate of PP was 54.4%; a longer duration of the index episode (p < 0.05) and longer latency between the index PP and next pregnancy predicted a subsequent PP. The rate of subsequent non-puerperal episodes was 69%, and all these episodes were bipolar. CONCLUSIONS Postpartum psychosis is difficult to predict in women with no antecedent history and is associated with a high rate of subsequent puerperal and non-puerperal illness. Risk of further illness needs to be conveyed in order to allow fully informed decisions to be made regarding future pregnancies.
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Affiliation(s)
- Emma Robertson Blackmore
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas G O’Connor
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Xiang Liu
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Wan Tang
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Nick Craddock
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
| | - Ian Jones
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
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