Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis
- PMID: 23651079
- PMCID: PMC3740048
- DOI: 10.1111/bdi.12071
Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis
Abstract
Objectives: Women who experience postpartum psychosis (PP) seek guidance on further pregnancies and risk of illness; however, empirical data are limited. This study describes reproductive and mental health outcomes in women diagnosed with PP and examines clinical risk factors as predictors of further illness.
Methods: A retrospective cohort design was used; 116 women who experienced episodes of mania or depression with psychotic features within six weeks of childbirth were recruited. All subjects underwent clinical diagnostic interviews and medical case notes were reviewed.
Results: Only 33% of women had an antecedent history, of which 34% had bipolar disorder and 55% unipolar depression. Only 58% of those with PP in their first pregnancy had a subsequent pregnancy, and 18% of marriages ended following the PP episode. Clinical presentation at the time of initial episode did not influence the timing of the onset of symptoms, treatment, or recovery. Although 86% of patients received treatment within 30 days of onset, 26% of women reported ongoing symptoms at a year after delivery. The recurrence rate of PP was 54.4%; a longer duration of the index episode (p < 0.05) and longer latency between the index PP and next pregnancy predicted a subsequent PP. The rate of subsequent non-puerperal episodes was 69%, and all these episodes were bipolar.
Conclusions: Postpartum psychosis is difficult to predict in women with no antecedent history and is associated with a high rate of subsequent puerperal and non-puerperal illness. Risk of further illness needs to be conveyed in order to allow fully informed decisions to be made regarding future pregnancies.
Keywords: perinatal psychiatry; postpartum psychosis; pregnancy; recurrence.
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Conflict of interest statement
The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.
Figures
Similar articles
-
Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations.Arch Gen Psychiatry. 2007 Jan;64(1):42-8. doi: 10.1001/archpsyc.64.1.42. Arch Gen Psychiatry. 2007. PMID: 17199053
-
Perinatal episodes across the mood disorder spectrum.JAMA Psychiatry. 2013 Feb;70(2):168-75. doi: 10.1001/jamapsychiatry.2013.279. JAMA Psychiatry. 2013. PMID: 23247604
-
Long-term outcome of severe puerperal psychiatric illness: a 23 year follow-up study.Psychol Med. 2000 Nov;30(6):1263-71. doi: 10.1017/s0033291799003025. Psychol Med. 2000. PMID: 11097067
-
Clinical course of illness in women with early onset puerperal psychosis: a 12-year follow-up study.J Clin Psychiatry. 2014 Oct;75(10):1096-104. doi: 10.4088/JCP.13m08769. J Clin Psychiatry. 2014. PMID: 25373118
-
Suicidal Ideation.2022 May 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. 2022 May 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 33351435 Free Books & Documents.
Cited by 23 articles
-
Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women.Int J Bipolar Disord. 2021 Oct 28;9(1):31. doi: 10.1186/s40345-021-00236-2. Int J Bipolar Disord. 2021. PMID: 34708260 Free PMC article.
-
First perinatal psychiatric episode among refugee and family-reunified immigrant women compared to Danish-born women: a register-based study.Soc Psychiatry Psychiatr Epidemiol. 2021 Dec;56(12):2239-2250. doi: 10.1007/s00127-021-02104-x. Epub 2021 May 18. Soc Psychiatry Psychiatr Epidemiol. 2021. PMID: 34008058
-
A new molecular risk pathway for postpartum mood disorders: clues from steroid sulfatase-deficient individuals.Arch Womens Ment Health. 2021 Jun;24(3):391-401. doi: 10.1007/s00737-020-01093-1. Epub 2020 Nov 20. Arch Womens Ment Health. 2021. PMID: 33219387 Free PMC article. Review.
-
Positive screening rates for bipolar disorder in pregnant and postpartum women and associated risk factors.Gen Hosp Psychiatry. 2019 Nov-Dec;61:53-59. doi: 10.1016/j.genhosppsych.2019.09.002. Epub 2019 Oct 22. Gen Hosp Psychiatry. 2019. PMID: 31710859 Free PMC article.
-
Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England.BMJ Open. 2019 Jul 24;9(7):e030208. doi: 10.1136/bmjopen-2019-030208. BMJ Open. 2019. PMID: 31345982 Free PMC article.
Publication types
MeSH terms
Grant support
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous