Contribution of psychological and social factors to psychotic and non-psychotic relapse after childbirth in women with previous histories of affective disorder

doi:10.1016/0165-0327(92)90110-R

Journal of Affective Disorders

Volume 24, Issue 4, April 1992, Pages 253-263

https://doi.org/10.1016/0165-0327(92)90110-R Get rights and content

Abstract

Twenty-six women with a history of bipolar or schizoaffective disorder, 17 women with histories of major depressive disorder and 45 control women without any previous psychiatric history were assessed in the 9th month of pregnancy on selected psychosocial measures. No subject was a ‘case’ as defined by the Research Diagnostic Criteria (RDC) from this time until the delivery. Within 6 months postpartum, 22 (51%) of the women with histories of mental illness were categorised as having relapsed (RDC case). Twelve women developed a psychosis (mania, hypomania or schizomania) and these illnesses occurred only in women with histories of affective or schizoaffective psychosis whereas 10 other women who became depressed after delivery came equally from the women with histories of psychosis (N = 5) as from those with histories of major depression (N = 5). Three (7%) control women also developed postpartum non-psychotic depressive disorders. Multivariate analyses suggest that different psychosocial factors contribute to the recurrence of affective and schizoaffective psychosis after delivery as opposed to non-psychotic postpartum affective disorders. A non-psychotic illness was predicted by antenatal neuroticism and a severe life event before illness onset. A recurrence of psychosis postpartum was predicted by a history of mania, hypomania or schizomania, a more recent psychiatric admission and reported marital difficulties. In this sample of women, life stress led to postpartum depression irrespective of the subject's past history and the high rates of recurrence of affective or schizoaffective psychosis (47%) probably mainly reflected a pre-existing physiological or psychological vulnerability which may have been exacerbated by, or contributed to, marital difficulties.

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Cited by (101)

Perinatal sleep disruption and postpartum psychosis in bipolar disorder: Findings from the UK BDRN Pregnancy Study
2024, Journal of Affective Disorders
Women with bipolar disorder (BD) are at high risk of postpartum psychosis (PP). The factors that increase risk of PP among women with BD are not fully understood. Here, we examine whether sleep disruption in the perinatal period (poor sleep quality in late pregnancy and sleep deprivation related to childbirth) is associated with PP in a longitudinal study of pregnant women with BD.
Participants were 76 pregnant women with lifetime DSM-5 bipolar I disorder or schizoaffective-BD, followed from week 12 of pregnancy to 12 weeks postpartum. Demographics and lifetime psychopathology were assessed at baseline via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry). Psychopathology and sleep disruption within the current perinatal period were assessed in the third trimester and at 12 weeks postpartum. Data were supplemented by clinician questionnaires and case-note review.
After controlling for prophylactic use of mood stabilising medication, the loss of at least one complete night of sleep across labour/delivery was associated with five times the odds of experiencing PP compared to no or less than one night of sleep loss across labour/delivery (OR 5.19, 95 % CI 1.45–18.54; p = 0.011). Sleep quality in late pregnancy was not associated with PP, and perinatal sleep disruption was not associated with postpartum depression.
Lack of objective measures of sleep factors.
In the context of other aetiological factors, severe sleep loss associated with childbirth/the immediate postpartum may act as a final trigger of PP. These findings could have important clinical implications for risk prediction and prevention of PP.
Borderline personality traits are differently associated with postpartum psychosis and postpartum depression episodes in women with bipolar disorder
2023, Journal of Affective Disorders
Women with bipolar disorder have approximately 40 %–50 % chance of having a perinatal bipolar recurrence. Knowing the factors associated will be beneficial for the prediction and prevention of episodes. We aim to establish if borderline personality disorder traits, as measured by the BEST (Borderline Evaluation of Severity over Time) scale, are associated with perinatal psychiatric outcomes.
We recruited women with bipolar disorder as part of the BDRN (Bipolar Disorder Research Network) study. Women were interviewed and we collected their demographic and clinical information. Participants subsequently completed the BEST questionnaire. We analysed the association of BEST scores with lifetime presence/absence of perinatal bipolar relapse and, employing multinomial logistic regression, with different subtypes of perinatal outcomes: postpartum psychosis; postpartum depression, and other episodes.
In our sample of 807, although there was no significant association between the BEST total score and perinatal episodes as a whole (adjustedOR 1.01 CI95% [0.99, 1.03], p = 0.204), we found significant differing associations with different subtypes of episodes. Women scoring highly on BEST were less likely to experience a postpartum psychotic episode (RRR 0.96 CI95% [0.94, 0.99], p = 0.005) but more likely to experience a non-psychotic depressive episode (RRR 1.03 CI95% [1.01, 1.05], p = 0.007) than no relapse.
This study is limited by its cross-sectional design and self-report nature of BEST.
In women with bipolar disorder, borderline traits differentiate the risk of postpartum depression and postpartum psychosis, emphasise the importance of considering risk factors for these perinatal episodes separately, and may help individualise the risk for women in the perinatal period.
Differences in interactional behaviour in postpartum depression with and without pre-existing mental disorder
2021, Comprehensive Psychiatry
Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD.
The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder.
Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the “Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter” (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined.
Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment.
Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.
A Matched Cohort Study of Postpartum Placentophagy in Women With a History of Mood Disorders: No Evidence for Impact on Mood, Energy, Vitamin B<inf>12</inf> Levels, or Lactation
2019, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
In a previous study, the most commonly reported motivation for women to engage in postpartum placentophagy was to improve mood.3 However, our data show that among women with the greatest need for an intervention to improve postpartum mood (given the increased risks for postpartum episodes associated with a history of a mood disorder,27,28), there was no significant difference in postpartum mood symptoms between women who consumed their placenta and those who did not. Similarly, we found no differences between the cohorts in terms of energy levels.
Although empirical studies investigating its effects are scarce, postpartum placentophagy is increasing in popularity because of purported benefits on mood, energy, lactation, and overall nutrition. Therefore, this study sought to test the hypotheses that women who consumed their placenta (placentophagy exposed [PE]) would have (1) fewer depressive symptoms, (2) more energy, (3) higher vitamin B₁₂ levels, and (4) less pharmaceutical lactation support during the postpartum than women who did not consume their placenta (non–placentophagy exposed [NE]).
Using data from a large, longitudinal study of gene × environment effects involving perinatal women with a history of mood disorders, the study investigators identified a PE cohort and matched them 4:1 (by psychiatric diagnosis, psychotropic medication use, supplementation, income, and age) with an NE cohort from the same dataset. The study investigated differences between the PE and NE cohorts with respect to scores on the Edinburgh Postnatal Depression Scale and Sleep-Wake Activity Inventory, vitamin B₁₂ levels, and the use of pharmaceutical lactation support (Canadian Taskforce Classification II-2).
The sample of 138 women (28 in the PE cohort, matched to 110 in the NE cohort) provided 80% power at α = 0.0125 to detect an effect of moderate magnitude (which can be used to approximate an effect of clinically significant magnitude).There were no differences in Edinburgh Postnatal Depression Scaleor Sleep-Wake Activity Inventory scales (P = 0.28 and P = 0.39, respectively), vitamin B₁₂ levels (P = 0.68), or domperidone use (P = 1) between the PE and NE cohorts.
These data provide no support for the idea that postpartum placentophagy improves mood, energy, lactation, or plasma vitamin B₁₂ levels in women with a history of mood disorders.
Bien que les études empiriques sur le sujet soient rares, la placentophagie post-partum gagne en popularité en raison de ses prétendus effets bénéfiques sur l'humeur, l'énergie, la lactation et la nutrition en général. Cette étude visait donc à vérifier l'hypothèse selon laquelle les femmes qui consomment leur placenta (exposées à la placentophagie [EP]) présenteraient 1) moins de symptômes dépressifs; 2) plus d'énergie; 3) des taux plus élevés de vitamine B₁₂ et 4) une utilisation moindre de médicaments stimulant la lactation pendant le post-partum comparativement aux femmes qui ne consomment pas leur placenta (non exposées à la placentophagie [NE]).
À l'aide des données d'une importante étude longitudinale portant sur les impacts des interactions gènes-environnement chez les femmes périparturientes ayant des antécédents de troubles de l'humeur, les chercheurs ont créé une cohorte EP et ont associé à chaque femme EP quatre femmes NE (appariées selon le diagnostic psychiatrique, l'usage de psychotropes, la prise de suppléments, le revenu et l'âge) faisant partie du même ensemble de données. L'étude s'est intéressée aux différences entre les cohortes EP et NE en ce qui concerne les résultats à l'Échelle de dépression post-partum d'Édimbourg et au Sleep-Wake Activity Inventory, les taux de vitamine B₁₂ et l'utilisation de médicaments stimulant la lactation (Classification II-2 du Groupe d'étude canadien).
L'échantillon de 138 femmes (28 dans la cohorte EP et 110 dans la cohorte NE) offrait une puissance de 80 % pour α = 0,0125 dans la détection d'un effet modéré (pouvant être utilisé pour estimer un effet cliniquement significatif). Il n'y avait pas de différence entre la cohorte EP et la cohorte NE dans les résultats à l'Échelle de dépression post-partum d'Édimbourg ou aux échelles du Sleep-Wake Activity Inventory (P = 0,28 et P = 0,39, respectivement), les taux de vitamine B₁₂ (P = 0,68), ou l'usage de dompéridone (P = 1).
Ces données n'appuient pas l'idée selon laquelle la placentophagie post-partum améliorerait l'humeur, l'énergie, la lactation ou le taux plasmatique de vitamine B₁₂ chez les femmes présentant des antécédents de troubles de l'humeur.
Clinical phenotypes of postpartum psychosis
2019, Biomarkers of Postpartum Psychiatric Disorders
Postpartum psychosis (PPP) is a rare and serious psychiatric disorder occurring in the early postnatal period. Some consider PPP a distinct clinical entity with characteristic symptoms, such as mood lability, decreased sleep, delusions, disorganized and erratic behavior, and perplexity/confusion. Others consider PPP to encompass any psychotic illness occurring in the postpartum period, such as postpartum depression or an exacerbation of schizophrenia. A personal history of bipolar disorder, as well as a prior episode of PPP, significantly increases the risk of developing PPP. With a high suicide (4%) and infanticide rate (4%), it is a psychiatric emergency and needs prompt evaluation in a monitored setting. Diagnosis involves excluding other forms of organic psychosis such as thyroid disease and infection. There are no validated screening tools, but all women should be screened for a personal and family history of mental illness—especially bipolar disorder and PPP.
Life events in schizoaffective disorder: A systematic review
2018, Journal of Affective Disorders
Citation Excerpt :
Furthermore, Brockington et al. examined life events in women with postpartum depression and in women with puerperal psychosis (including schizoaffective mania and schizoaffective depression), reporting that the depressed group had twice the probability of an event approximately 38 months before illness onset (Brockington et al., 1990). However, nothing was proved about participation of stress in manic disorders (Marks et al., 1992). Finally, one more factor influencing the outcome of schizoaffective disorder is suicidality, which is not a life event of course, but it is affected by life events and especially by PTSD (Psychiatry, 1996).
Life events play a central role in the development of psychiatric disorders and impact course and outcome. We present a systematic review of the literature on the relationship of life events with the onset and long-term course of schizoaffective disorder.
MEDLINE was searched with the combination of the key words: ‘life events’ plus ‘schizoaffective’. The PRISMA method was followed in the review process.
From the identified 66 papers only 12 were considered to be of relevance to the current study and 6 more papers were identified by inspecting the reference lists of the identified papers.
There are very few studies focusing on the role of life events in schizoaffective disorder indicating insufficient data concerning the relationship of life events with onset and long-term course of schizoaffective disorder. Reported effects are not generic but concern specific events like the loss of mother, and females seem to be more vulnerable. Patients with schizoaffective disorder manifest high rates of PTSD.
The literature on life events with the development and course of schizoaffective disorder is limited and precludes solid conclusions.

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Contribution of psychological and social factors to psychotic and non-psychotic relapse after childbirth in women with previous histories of affective disorder

Abstract

J. Psychosom. Res.

J. Affective Disord.

Predictability of course of illness in manic patients positive for life events

J. Nerv. Ment. Dis.

Life events and mania. A special relationship?

Br. J. Psychiatr.

Life events and relapse in bipolar disorder: The impact of a catastrophic event

Acta Psychiatr. Scan.

Stress and puerperal psychosis

Br. J. Psychiatr.

Puerperal Psychosis

Self-esteem and depression III. Aetiological Issues

Soc. Psychiatry Psychiatr. Epidemiol.

Threatening life events in the onset of schizophrenia, schizophreniform psychosis and hypomania

Br. J. Psychiatr.

The construction, development and testing of a self-report questionnaire to identify social problems

Psychol. Med.

The symptomatology of puerperal illness

Br. J. Psychiatr.

Is puerperal psychosis the same as bipolar manic depressive disorder? A family study

Psychol. Med.

Life events and social stress in puerperal psychoses: absence of effect

Psychol. Med.

Manual of the Eysenck Personality Questionnaire

Premorbid personality assessments of first onset of major depression

Arch. Gen. Psychiatr.

The social and obstetric correlates of psychiatric admission in the puerperium

Psychol. Med.