Post-partum psychoses: Clinical diagnoses and relative risk of admission after parturition

KAS Glostrup, Psychiatric Department P, Denmark.
The British Journal of Psychiatry (Impact Factor: 7.99). 07/1998; 172:521-6.
Source: PubMed


Previous studies have suggested that the risk for psychosis, especially affective psychosis, is highly increased during the first 30 days after delivery. The aim of our study was to replicate these findings.
Linking The Danish Medical Birth Register and The Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1253 admissions diagnosed as psychosis within 91 days after delivery. The admission rate after delivery was compared with the admission rate among non-puerperal women in the general Danish female population.
The relative risk of all admissions was only slightly increased, RR = 1.09 (95% CI 1.03-1.16). The admission rate concerning first admissions was highly increased, RR = 3.21 (95% CI 2.96-3.49) whereas the admission rate concerning readmissions was reduced, RR = 0.66 (95% CI 0.61-0.72).
Childbirth is a strong risk factor for first admission with psychosis, but the risk may be less increased than previously assumed.

Download full-text


Available from: Preben B Mortensen, Jun 09, 2014
  • Source
    • "Suffering from postpartum psychosis (PPP) calls for all possible forms of support as this is a rare illness [1] [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to describe Swedish psychiatrists’ experiences of involving the family in the treatment of women with postpartum psychosis. A qualitative design was used, and semistructured qualitative research interviews were conducted with nine psychiatrists from the south of Sweden. Data were analysed using qualitative content analysis. Four categories were found: the family as a resource , the family as coworkers , preparing the family for the future , and the family as a burden . The result showed that the psychiatrists considered the family to be a resource to which they devoted a great deal of care and effort. It was particularly important to involve the partner, informing about the course of the illness and the steps that need to be taken in the event of a relapse and reducing any guilt feelings. The psychiatrists instilled confidence and hope for a future of health and further child bearing. The family members’ limited understanding of the treatment may impede the involvement of the family. Conclusion of the study was that the goal for family involvement was to facilitate the women’s care and treatment. Further studies are needed to provide suggestions on how to develop family involvement in the care of women suffering from postpartum psychosis.
    Full-text · Article · Jan 2013
  • Source
    • "Although two epidemiological surveys ( Kendell et al . , 1987 ; Terp and Mortensen , 1999 ) reported the incidence of postpartum psychosis as somewhat less than 1 / 1000 deliveries , no study , to our knowledge , has reported specifically on the incidence of postpartum depression . A survey in Lundby , Sweden , ( Hagnell et al . "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aims of this study were to assess rates of bipolar spectrum disorders in women experiencing their first episode of postpartum depression, and to find out features indicative of bipolarity in these patients. As part of the international BRIDGE study designed to detect hypo/mania in patients with a major depressive episode, 52 (5.85%) were found to experience a first episode of postpartum (FEPP) depression, whereas 833 (94.13%) had a first episode of nonpostpartum (FENPP) depression. Hypo/mania was assessed using varying definitions of bipolarity, and the two groups compared on sociodemographic, family history and clinical characteristics. Compared to FENPP depressive patients, women with FEPP depression had higher rates of bipolar disorders, with more hypo/mania in first degree relatives. Psychotic symptoms, atypical features, mixed depression, younger age at onset, high number of prior episodes, episodes of short duration, switches on antidepressants, seasonality of mood episodes as well as mood episodes with free intervals were found to be more frequent in FEPP depressives. The following are the limitations of this study: centres not randomly selected, recall bias, cross-sectional design, and limited training of participating psychiatrists. This study confirms, in women experiencing a first depressive episode, high rates (15 to 50%) of bipolar disorders during the postpartum period and is the first to systematically assess and demonstrate the higher prevalence of identifying features of bipolarity in FEPP versus FENPP depression. Early recognition of bipolarity in these patients may help prevent the harmful consequences of this illness.
    Full-text · Article · Oct 2011 · Journal of Affective Disorders
  • [Show abstract] [Hide abstract]
    ABSTRACT: Psychotische Erkrankungen von Frauen nach der Entbindung eines Kindes werden als Wochenbettpsychosen, Puerperalpsychosen oder Postpartumpsychosen bezeichnet. Ihr Manifestationszeitraum sind die ersten postpartalen Tage bis wenige Wochen nach der Geburt. Sie sind auf einer syndromalen Ebene einerseits von den so genannten „Heultagen“, denen kein Krankheitswert im engeren Sinne zukommt, und andererseits von den postnatalen Depressionen abzugrenzen, die meist erst später auftreten und auch in der Regel ohne psychotische Symptome einhergehen. Das klinische Bild wird entweder von zykloiden bzw. schizoaffektiven, maniformen oder von schweren depressiv-psychotischen Symptomen charakterisiert. Der weitere Verlauf von Wochenbettpsychosen ist differenziell zu sehen. Für die Subgruppe von Frauen mit zykloiden Psychosen im Indexzeitraum besteht insgesamt eine stärkere Nähe zu den bipolar affektiven Störungen als zu den schizophrenen Psychosen. In diese Richtung weisen auch Familienstudien. Das Wiedererkrankungsrisiko ist sowohl nach erneuten Schwangerschaften als auch in anderen Lebensabschnitten bedeutsam erhöht. Eine Subgruppe von betroffenen Frauen bleibt aber im weiteren Verlauf frei von psychotischen Rezidiven. Die Ätiopathogenese von Wochenbettpsychosen ist multifaktoriell zu diskutieren, wobei neurobiologische Faktoren vermutlich eine gewichtigere Rolle als psychosoziale Faktoren spielen. Der Zusammenhang zur neuroendokrinologischen Umstellung postpartal ist wahrscheinlich anzunehmen, aber letztlich noch wenig verstanden. Psychosoziale Faktoren scheinen aber den Verlauf bedeutsam zu beeinflussen. Psychotic illnesses in women after giving birth to a baby are called puerperal or postpartum psychoses. These puerperal psychoses mainly manifest in the first days till few weeks after delivery. On a clinical level they must be differentiated from so called “postpartum blues” that may be considered a basic psychobiological adjustment reaction without a proper state as disorder on the one hand, from postnatal depressions that typically manifest later and are without psychotic symptoms on the other. Cycloid, schizoaffective, manic or psychotic-depressive symptoms prevail in puerperal psychoses. Cycloid psychoses during the postpartum period seem to be linked more pronouncedly to bipolar affective than to schizophrenic disorders in the further course of illness as is indicated by clinical follow up and family studies. There is a major risk of psychotic relapses both after further pregnancies and also in other non-index periods. A subgroup of affected women, however, will not suffer from any further psychoses. In respect of aetiopathogenesis research literature underlines major neurobiological influences outweighing psychosocial factors. A significant link to the neuroendocrine changes in the early postpartum period is indicated, the basic mechanisms, however, are only poorly understood. Psychosocial factors such as social support or quality of marital relation on the other hand may have an impact on the further course of illness. SchlüsselwörterWochenbettpsychose-Postpartumpsychose-Puerperalpsychose-bipolar affektive Störung KeywordsPostpartum psychosis-puerperal psychosis-bipolar affective disorder
    No preview · Article · Sep 2010 · Psychiatrie und Psychotherapie
Show more