Psychotic Illness in First-Time Mothers with No Previous Psychiatric Hospitalizations: A Population-Based Study

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
PLoS Medicine (Impact Factor: 14.43). 02/2009; 6(2):e13. DOI: 10.1371/journal.pmed.1000013
Source: PubMed


Psychotic illness following childbirth is a relatively rare but severe condition with unexplained etiology. The aim of this study was to investigate the impact of maternal background characteristics and obstetric factors on the risk of postpartum psychosis, specifically among mothers with no previous psychiatric hospitalizations.
We investigated incidence rates and potential maternal and obstetric risk factors of psychoses after childbirth in a national cohort of women who were first-time mothers from 1983 through 2000 (n = 745,596). Proportional hazard regression models were used to estimate relative risks of psychoses during and after the first 90 d postpartum, among mothers without any previous psychiatric hospitalization and among all mothers. Within 90 d after delivery, 892 women (1.2 per 1,000 births; 4.84 per 1,000 person-years) were hospitalized due to psychoses and 436 of these (0.6 per 1,000 births; 2.38 per 1,000 person-years) had not previously been hospitalized for any psychiatric disorder. During follow-up after the 90 d postpartum period, the corresponding incidence rates per 1,000 person-years were reduced to 0.65 for all women and 0.49 for women not previously hospitalized. During (but not after) the first 90 d postpartum the risk of psychoses among women without any previous psychiatric hospitalization was independently affected by: maternal age (35 y or older versus 19 y or younger; hazard ratio 2.4, 95% confidence interval [CI] 1.2 to 4.7); high birth weight (> or = 4,500 g; hazard ratio 0.3, 95% CI 0.1 to 1.0); and diabetes (hazard ratio 0).
The incidence of psychotic illness peaks immediately following a first childbirth, and almost 50% of the cases are women without any previous psychiatric hospitalization. High maternal age increases the risk while diabetes and high birth weight are associated with reduced risk of first-onset psychoses, distinctly during the postpartum period.


Available from: Pär Sparén, Dec 23, 2013
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    • "In our study, the number of antenatal checkups and the type of delivery did not influence PP. Some authors related cesarean section with postpartum psychosis,[2425] but other studies did not support it.[18] "
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    ABSTRACT: Background:A better understanding of risk factors associated with postpartum psychosis may contribute to the better management.Aims:This study was to identify the risk factors contributing to postpartum psychosis.Materials and Methods:In this cross-sectional, case control study 100 patients of postpartum psychosis (PP) were compared with the healthy controls. Risk factors explored were sociodemographic factors (age, education, occupation, income, and family type); positive family history; pregnancy and perinatal factors (number of antenatal check-up, parity, and complications during pregnancy, perinatal phase or in newborn); and presence of husband during peripartum period. Data were analyzed by graph pad instat software using chi square test and Fisher's exact test.Results:Total of 64% patients and 42% controls were less than 25 years of age (P = 0.001). Among the patients, 62% were primiparae compared with 46% in the controls (P = 0.02). Per capita family income was less than 5000 INR in 72% patients and 56% controls (P = 0.01). Maternal complications during perinatal period were observed in 38% patients and 22% controls (P = 0.01), while the complications in newborns were seen in 21% patients and 8% controls (P = 0.009). Husband was present in 58% patients and 76% controls. (P = 0.006).Conclusions:The risk factors related to PP were younger age, lower per capita income, perinatal and neonatal complications, and absence of husband in peripartum phase.
    North American Journal of Medical Sciences 06/2014; 6(6):274-7. DOI:10.4103/1947-2714.134373
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    • "The triggering role of childbirth causes a clustering of mood episodes which has been reported in more than 50 % of women with children (Viguera et al. 2011) with an exponential rise in the rates of hospitalization immediately following delivery among women with bipolar disorder (Pugh et al. 1963; Harlow et al. 2007; Valdimarsdottir et al. 2009). Results of a recent investigation on a large US female population with mood disorders found that mood episodes are 3.5 times more prevalent during the postpartum period than during pregnancy and that the risk is consistently higher with bipolar disorder than with unipolar disorder (Viguera et al. 2011). "
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    ABSTRACT: The postpartum period is considered a time of heightened vulnerability to bipolar disorder. The primary goal of this study was to examine the frequency and the polarity of postpartum episodes in a clinical sample of women with bipolar disorder who were medication-free during their pregnancies. In addition, we sought to examine whether there are differences in terms of clinical features of bipolar disorder between women with and without postpartum episodes. Lastly, we analyzed the potential relationship between polarity of the postpartum episodes and clinical features of bipolar disorder. The presence/absence of postpartum episodes and their characteristics were obtained from medical records of 276 women with bipolar disorder who were medication-free during their pregnancies. Two hundred seven women (75.0 %) had a history of one or more postpartum mood episodes: depressive (79.7 %), (hypo)manic (16.4 %), or mixed episodes (3.9 %). Psychotic symptoms during postpartum episodes were associated with depression in 37 (22.4 %) patients, with mania in 19 (67.8 %) patients, and with mixed episodes in 7 (87.5 %) patients. Postpartum manic and mixed episodes were significantly associated with type I disorder and with psychotic features. Our findings indicate high risk of clinically ascertained mood episodes during postpartum period in bipolar women who are not treated during pregnancy.
    Archives of Women s Mental Health 01/2014; 17(5). DOI:10.1007/s00737-013-0405-4 · 2.16 Impact Factor
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    • "It is important to develop knowledge concerning nursing presence in relation to caring for women with PPP, as this illness is one of the most serious types of post-partum psychiatric disorders. PPP occurs in 0.1– 0.2% of women who have just given birth (Brockington 2004; Spinelli 2009; Valdimarsdottir et al. 2009), with an incidence of 5% for suicide and 4% for infanticide (Knops 1993; Lindahl et al. 2005). The onset of PPP is usually rapid, as early as 1–3 days immediately after childbirth, with 22% occurring on the first post-partum day (Heron et al. 2007; Okano et al. 1998). "
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    ABSTRACT: The concept of nursing presence has been widely used in nursing and is a significant component of nursing practice. In order to increase our understanding of nursing presence, it needs to be studied in different contexts. In this study, a secondary analysis of interviews with 10 registered psychiatric nurses (RPN) in Sweden was conducted to explore nurses' descriptions of presence when caring for women with post-partum psychosis (PPP). Based on the research question: 'How do RPN describe nursing presence in the context of caring for women with PPP?' content analysis was used to analyze the data. Three categories emerged: the use of presence to protect, the use of presence to facilitate recovery, and the use of presence for learning. The findings underscore the importance of recognizing nursing presence as a strategy to improve psychiatric nursing for the benefit of the woman and her child, and as an important part of psychiatric nursing when providing compassionate and effective nursing care to this population.
    International journal of mental health nursing 10/2010; 19(5):313-21. DOI:10.1111/j.1447-0349.2010.00691.x · 1.95 Impact Factor
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