First-Onset Psychosis Occurring in the Postpartum Period: A Prospective Cohort Study

被引:63
作者
Bergink, Veerle [1 ]
Lambregtse-van den Berg, Mijke P. [1 ,2 ]
Koorengevel, Kathelijne M. [1 ]
Kupka, Ralph [3 ]
Kushner, Steven A. [1 ]
机构
[1] Erasmus MC, Dept Psychiat, Univ Med Ctr, Rotterdam, Netherlands
[2] Erasmus MC, Dept Child & Adolescent Psychiat, Univ Med Ctr, Rotterdam, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, Dept Psychiat, Amsterdam, Netherlands
关键词
AFFECTIVE PUERPERAL PSYCHOSIS; FOLLOW-UP; BIPOLAR DISORDER; PSYCHIATRIC-DISORDERS; DEPRESSION; DIAGNOSIS; SYMPTOMATOLOGY; RECURRENCE; ILLNESSES; OXYTOCIN;
D O I
10.4088/JCP.10m06648
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Objective: To prospectively characterize a cohort of patients for whom first lifetime episode of psychosis occurs in the postpartum period. Method: Included in the study were 51 women admitted to an inpatient facility for postpartum psychosis and a population-based control group (n = 6,969). All patients received naturalistic treatment using the sequential addition of benzodiazepines, antipsychotics, and lithium. A clinician-administered questionnaire and parallel history provided information about obstetric history, pregnancy, delivery, breastfeeding, neonatal outcomes, and onset of the disease. Clinical remission was defined as the absence of psychotic, manic, and depressive symptoms for at least 1 week, The primary outcome measure was the Clinical Global Impressions-Severity scale. The study was conducted from 2005 to 2009. Results: Compared to the general population sample, women with postpartum psychosis had a significantly higher incidence of primiparity (OR = 2.90; 95% CI, 1.49-5.67) but had no significant differences in delivery-related, lactational, or neonatal-related risk factors. The median onset of psychiatric symptoms occurred at 8 days' postpartum (interquartile range [IQR], 5-14), and median duration of episode was 40 days (IQR, 23-69). Patients with prominent depressive symptoms had a significantly later onset (P = .01) of psychosis and a longer duration of episode (P < .01) than patients without depressive symptoms. Psychotic symptoms were mood-incongruent in 64.7% of patients. Conclusions: In contrast to other findings related to postpartum psychosis in bipolar patients, no delivery-related, neonatal-related, or lactational risk factors could be identified. Further, our findings of a delayed onset and mood incongruence of postpartum psychotic symptoms markedly contrasts with that of patients with a previous history of bipolar disorder. These results suggest that women with psychosis limited to the postpartum period might have a distinct risk profile and phenomenology.
引用
收藏
页码:1531 / 1537
页数:7
相关论文
共 44 条
[1]  
[Anonymous], 1976, CLIN GLOBAL IMPRESSI
[2]  
[Anonymous], 1997, STRUCTURED CLIN INTE
[3]   PUERPERAL PSYCHOSES - A CLINICAL CASE-STUDY WITH FOLLOW-UP [J].
BENVENUTI, P ;
CABRAS, PL ;
SERVI, P ;
ROSSETI, S ;
MARCHETTI, G ;
PAZZAGLI, A .
JOURNAL OF AFFECTIVE DISORDERS, 1992, 26 (01) :25-30
[4]   Postpartum Depression With Psychotic Features [J].
Bergink, Veerle ;
Koorengevel, Kathelijne M. .
AMERICAN JOURNAL OF PSYCHIATRY, 2010, 167 (04) :476-477
[5]   Obstetric variables associated with bipolar affective puerperal psychosis [J].
Blackmore, ER ;
Jones, I ;
Doshi, M ;
Haque, S ;
Holder, R ;
Brockington, I ;
Craddock, N .
BRITISH JOURNAL OF PSYCHIATRY, 2006, 188 :32-36
[6]  
BROCKINGTON IF, 1981, ARCH GEN PSYCHIAT, V38, P829
[7]   Oxytocin as a natural antipsychotic: a study using oxytocin knockout mice [J].
Caldwell, H. K. ;
Stephens, S. I. ;
Young, W. S., III .
MOLECULAR PSYCHIATRY, 2009, 14 (02) :190-196
[8]   The relationship between postpartum psychosis and bipolar disorder: A review [J].
Chaudron, LH ;
Pies, RW .
JOURNAL OF CLINICAL PSYCHIATRY, 2003, 64 (11) :1284-1292
[9]   Postpartum bipolar episodes are not distinct from spontaneous episodes: Implications for DSM-V [J].
Colom, F. ;
Cruz, N. ;
Pacchiarotti, I. ;
Mazzarini, L. ;
Goikolea, J. M. ;
Popova, E. ;
Torrent, C. ;
Vietac, E. .
JOURNAL OF AFFECTIVE DISORDERS, 2010, 126 (1-2) :61-64
[10]   The Bipolar Affective Disorder Dimension Scale (BADDS) - a dimensional scale for rating lifetime psychopathology in Bipolar spectrum disorders [J].
Craddock, Nick ;
Jones, Ian ;
Kirov, George ;
Jones, Lisa .
BMC PSYCHIATRY, 2004, 4 (1)