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Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis
Author(s) -
Blackmore Emma Robertson,
Rubinow David R,
O'Connor Thomas G,
Liu Xiang,
Tang Wan,
Craddock Nick,
Jones Ian
Publication year - 2013
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12071
Subject(s) - postpartum psychosis , pregnancy , medicine , psychiatry , bipolar disorder , childbirth , psychosis , mental illness , mania , retrospective cohort study , depression (economics) , history of depression , postpartum period , obstetrics , pediatrics , psychology , mood , mental health , anxiety , macroeconomics , biology , economics , genetics
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.