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.

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Available from: Pär Sparén, Dec 23, 2013
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    • "She was not known to be taking any medications nor did she suffer from substance abuse. Considering the clinical picture and because of the presence of classical risk factors (first-time mother with multiple births associated with obstetrical complications, recent immigration, father of the children barely present), post-partum psychosis was firstly suspected even though the delayed onset of psychiatric symptoms 5 to 8 months after birth was longer than what is usually admitted for such a diagnosis[16]. As a consequence, oral risperidone 2 mg daily and cyamemazine 30 mg daily were introduced. "
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    ABSTRACT: Background Catatonia is a neuropsychiatric syndrome with motor and behavioural symptoms. Though usually occuring in patients with schizophrenia and mood disorders, this syndrome may also be associated with neurological diseases or general medical conditions. Few cases of catatonia associated with autoimmune disorders have been described. Case presentation Here, we report the case of a 27-year-old woman diagnosed with Hashimoto’s encephalitis (HE) who attempted suicide and infanticide by defenestration. As she presented risk factors for postpartum psychosis, she was treated principally with antipsychotics. Despite adequate treatment for psychosis, symptoms worsened and she developed catatonia. Complementary investigations showed elevated titres of anti-thyroglobulin and anti-thyroperoxidase antibodies (200 and 10 times, respectively, as compared to normal levels) and electroencephalography were suggestive of encephalopathy. In the presence of an otherwise unexplained neuropsychiatric condition, HE was suspected and oral prednisolone was introduced. Psychiatric symptoms improved dramatically within 72 h and the patient was still free of any symptom 3 years later. Conclusion Catatonia of organic aetiology should always be considered before a psychiatric aetiology especially in case of clinical worsening in spite of adequate psychotropic treatment. To our knowledge, this is the first description of catatonia associated with HE.
    Preview · Article · Dec 2016 · BMC Psychiatry
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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.
    Full-text · Article · Jun 2014 · North American Journal of Medical Sciences
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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.
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