Postpartum Onset of Manic Symptoms

From MindLinc Wiki

IN PATIENTS WITH POSTPARTUM ONSET OF MANIC SYMPTOMS IS THE INITIAL PRESENTATION AND RECURRENCE OF MANIA ATTRIBUTED OR IMPACTED BY THE POSTPARTUM STATE

Reference: Videbech P and Gouliaev G. 1995. First admission with puerperal psychosis: 7-14 years of follow-up. Acta Psychiatrica Scandinavica 91(3): 167-73.

Methods:

Design: Retrospective Cohort study

Setting: The study took place in Denmark where women were admitted to psychiatric hospitals for the first time with postpartum psychosis were identified by using the national personal identification number to link data from the Danish Psychiatric Central Register with the Danish Medical Birth register.

Inclusion Criteria: first admission to a psychiatric department in the years 1973 to 1980; admission within 12 months after a parturition; diagnosis at discharge was psychosis (ICD-8 290 to 299) and all admissions took place at the psychiatric departments in Arhus County, Arhus psychiatric hospital or the psychiatric wards in the cities of Silkeborg or Randers with a well-defined catchment of approximately 600,000 inhabitants.

Control Group: every proband had two controls with inclusion criteria of 1) they delivered at the same maternity ward in the same year and 2) they had same parity and approximately the same age.

Outcomes: Primary: Evaluate women who had first time diagnoses and admissions to psychiatric hospitals following delivery of the first child and compare certain demographical variables with those of the background population and to investigate whether obstetrical factors could contribute to the development of the disorder.

Description of Prognosis factors considered: Mental disorder, hospitalizations, medications and social functioning.

Validity

1. Was the patient sample clearly defined, representative of clinical practice, and captured in a similar point in disease progression? Yes
2. Was the duration of follow-up sufficient? Yes. Were all patients accounted for? Yes
3. Were outcome criteria objective and unbiased relative to prognostic factors? Yes
4. Was their adjustment for linked prognostic factors? No
5. Were pts in study treated similarly? Yes
6. Does the study population describe my patient? Yes, somewhat

Results

1. 50 cases were found to have a first episode of psychosis after within 1 yr of parturition for a freq of 1/1000. First -episode psychosis within the first month postpartum occurred in 1/2000 births.
2. Demographics; Age and socioeconomic status were equal to controls, but cases were primiparous more often than expected.
3. Birth complications did not occur more often than controls, but probands had a higher risk of preterm than the controls
4. Manic/depressive psychosis in 50%, but no schizophrenia. 60 % severe depression; 20% mania.
5. With follow-up; 40% of women had not regained full working capacity secondary to mental problem, with those with schizophreniform symptoms as a predictor of incapacity to work.
6. Recurrences were very common 60%, especially of the nonpuerpal type; and half the recurrences belonged to the manic-depressive types. Cases with exclusively puerperal episodes were rare 4%.

Strengths and Weaknesses

1. Selection bias was not a factor since records were used from register and pt. Agreement was not needed.
2. Criteria based on ICD-8 Criteria; retrospectively classified as DSM4 but unable to get the proper time intervals, 6 month criteria
3. Only general practitioners were interviewed which may not have allowed accurate information of symptoms.

Bottom line: There does not appear to be any obstetrical factors that contribute to the development of post­partum psychosis/mood disorder. The rate of recurrence in both post-partum and non-postpartum psychosis/mood disorder is high.