Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis

Neuropsychiatric Genetics Unit, Department of Psychological Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK.
The British Journal of Psychiatry (Impact Factor: 7.99). 04/2005; 186:258-9. DOI: 10.1192/bjp.186.3.258
Source: PubMed


The clinical value of information on the risk of future psychiatric illness in women who have experienced puerperal (post-partum) psychosis has been limited by inconsistencies in terminology and nosology. Here we report rates of subsequent puerperal and non-puerperal episodes, in a well characterised sample of women diagnosed with clearly defined bipolar affective puerperal psychosis (n=103). Out of 54 women having further children, 31(57%; 95% CI 44-69) experienced an additional puerperal psychotic episode, and 64 of 103 women (62%; 95% CI 52-71) experienced a non-puerperal affective episode during the follow-up period (mean duration 9 years). A history of bipolar episodes prior to the puerperal psychosis did not predict risk following subsequent pregnancies, but positive family history of mental illness predicted shorter time to non-puerperal relapse.

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    • "When students were asked which women were at increased risk of developing serious mental health problems, a minority of students (24%) recognised that women with a history of puerperal psychosis in a previous pregnancy had a 1 in 2–4 chance of developing this serious mental health problem again (Oates, 2003). Similarly, a minority of students (17%) realised that women with a previous history of bipolar disorder had a 1 in 2–4 chance of developing puerperal psychosis after giving birth (Robertson et al, 2005). When asked about their 'understanding of puerperal psychosis' , a large number of students (up to 15%) avoided answering these questions and left them unanswered. "
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    ABSTRACT: Background:Psychiatric illness is a leading indirect cause of maternal mortality. Earlier studies suggest serious discrepancies in the training and knowledge of midwives with regard to perinatal mental health. Aims:To explore the knowledge and experience of student midwives in the care of women with perinatal mental health problems. Methods:A modified questionnaire was distributed to student midwives near completion of 3-year and 78-week midwifery programmes. Results:Students often under-estimated the risk of women with existing mental health problems developing a serious mental health problem during pregnancy or in the postpartum period. Students felt ill-prepared and lacked confidence in caring for women with serious mental health problems. Conclusion:Recommendations from the findings of this study indicate (1) a review of undergraduate midwifery education in relation to perinatal mental health is needed; (2) a larger study, involving a more diverse sample of students, would enable generalisation to a wider population.
    British Journal of Midwifery 12/2014; 23(1):32. DOI:10.12968/bjom.2015.23.1.32
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    • "In this study, there were no associations between PND and the level of education, which was also noted by Grussu and Quantraro (2009) and Özbaoaran et al. (2011). Conversely, other studies have found education to be a predictor of PND (Araya et al., 2003; Artazcoz et al., 2004; Robertson et al., 2005; Grussu and Quantraro, 2009). Moreover, mothers who had a higher level of education were more at risk of postpartum depression in two relatively recent studies (Ersek and Huber, 2009; Vernon et al., 2010). "
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    ABSTRACT: Background: postnatal depression (PND) is defined as a psychological mood disorder that occurs in a mother within 6 weeks of her giving birth. It refers to an episode that causes mood disturbance and it could begin in, or extend into, the postpartum period. It is thought to have a high impact upon the mother's health as well as the family's functioning and the child's development. Socio-demographic, psych-social, and physical activity factors may all contribute to postpartum mood and ability to cope with responsibilities. The primary aim of this study was to determine which of these factors predicted PND in postpartum women. A secondary aim was to identify the socio-demographic and psycho-social predictors of physical activity in postpartum women. Methods: The study used a cross-sectional correlational design. A sample of 150 postpartum women was sent a package of six standardized questionnaires. Results: There was no association between physical activity and PND; however, older mothers, mothers of younger children, mothers who are less reluctant to ask for help, and mothers who are more satisfied with the help they get experience lower levels of PND. Mothers of older babies, mothers with more children, and less educated mothers are more likely to engage in caregiving activities, whereas mothers with fewer children and higher levels of partner support are more likely to engage in occupational activities. None of the socio-demographic factors or any of the parenting factors predicted levels of sporting activity.
    Frontiers in Psychology 05/2014; 5(597). DOI:10.3389/fpsyg.2014.00597 · 2.80 Impact Factor
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    • "One of the overall findings from the literature, seen in bipolar disorder recurrences after childbirth, as well as other domains including postpartum disorders, is that depression is the most frequent morbidity following pregnancy (Viguera et al. 2011), although it is also known that (hypo)manic symptoms are also common after delivery and occur in 9.6– 20.4 % of women in the early puerperium (Glover et al. 1994; Lane et al. 1997; Hasegawa 2000; Webster et al. 2003; Farias et al. 2007; Heron et al. 2009). Moreover, it has also been suggested that most cases of puerperal psychosis represent triggering by childbirth of episodes of bipolar disorder (Chaudron and Pies 2003; Robertson et al. 2005). "
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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.
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