Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis
ABSTRACT 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.
Article: Postpartum psychosis[Show abstract] [Hide abstract]
ABSTRACT: Key contentPostpartum psychosis is a severe mental illness with a dramatic onset shortly after childbirth.All women should be screened antenatally for the known risk factors.Women with bipolar disorder have at least a 1 in 4 risk and need close contact and review during the perinatal period even if they are well.Prompt recognition of the illness and rapid institution of treatment are of vital importance. Learning objectivesTo recognise women at high risk for severe postpartum mental illness.To recognise and appreciate the severity of postpartum psychosis and the need for prompt assessment and treatment. Ethical issuesWho should ultimately make decisions about taking medications in pregnancy – the clinician or the woman and her family?What advice should a woman at high risk of postpartum psychosis be given if she is considering pregnancy?The Obstetrician & Gynaecologist 07/2013; 15(3). DOI:10.1111/tog.12041
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ABSTRACT: Objective: This study explored women’s experience of puerperal psychosis (PP) and their perceptions of its cause, in order to contribute to an increased understanding of PP and promote consideration of new management perspectives. Background: Out of every 1000 live births, approximately one to two women will develop PP. The numbers are relatively small, yet the consequences can be devastating. Key theoretical explanations for the aetiology of PP are genetic, biochemical and endocrine. A small and relatively tenuous evidence base considers PP from a psychological perspective, despite acknowledgement of the need for broader understanding. A stress–vulnerability model has offered a contemporary explanation of psychotic symptoms in other contexts and non-clinical populations and may offer useful insight in relation to a psychobiological model of PP. Methods: In a qualitative study, seven women who had been diagnosed with PP previously were interviewed and the data subjected to an inductive thematic analysis. Trustworthiness and rigour of the study was assured by careful monitoring of the research process and data checking. Results: Four themes were identified – The path to PP; Unspeakable thoughts and unacceptable self; ‘Snap out of it’; and Perceived causes. While women attributed their PP to the physiological changes associated with childbirth, their accounts of PP began before and during pregnancy. Women highlighted stressful pregnancies characterised by significant challenges and emotions, difficult births and unsupportive family relationships postnatally. The experience of PP was extremely distressing. Conclusion: Findings add to the debate about a more multifaceted explanation of PP and potentially offer a psychobiological model of understanding.Journal of Reproductive and Infant Psychology 05/2014; 32(3). DOI:10.1080/02646838.2014.883597 · 0.67 Impact Factor
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ABSTRACT: The perinatal period is associated with an increased risk of severe mental disorders. We summarise the evidence regarding the epidemiology, risk factors, and treatment of severe mental illness in relation to childbirth, focusing on bipolar disorder, affective psychosis, and schizophrenia. We discuss women with ongoing chronic conditions and those with the onset of new episodes of post-partum psychosis. Despite the importance of perinatal episodes, with suicide a leading cause of maternal death, few studies are available to guide the management of women with severe mental disorders in pregnancy and the post-partum period. However, general principles of management are discussed, including the need for an individual risk-benefit analysis for each woman. Copyright © 2014 Elsevier Ltd. All rights reserved.The Lancet 11/2014; 384(9956):1789-99. DOI:10.1016/S0140-6736(14)61278-2 · 39.21 Impact Factor