Psychoza poporodowa – Rokowania, prognozy i postęp choroby

Psychoza poporodowa
Rokowania, prognozy i postęp choroby

Psychoza poporodowa, występująca u około 1 na 1000 kobiet po porodzie, jest stanem nagłym w psychiatrii wymagającym natychmiastowej interwencji. Mimo braku formalnego uznania w ICD-10 i DSM-5, zaburzenie to charakteryzuje się ciężkimi objawami trwającymi od 2 do 12 tygodni, z pełnym powrotem do zdrowia w ciągu 6-12 miesięcy lub dłużej przy odpowiednim leczeniu. Rokowanie jest korzystne, zwłaszcza przy pierwszym epizodzie, a krótszy czas trwania ostrego stanu koreluje z lepszymi wynikami. Meta-analiza obejmująca 645 kobiet wykazała, że 43,5% miało izolowaną psychozę poporodową bez nawrotów poza okresem poporodowym, podczas gdy 56,7% doświadczyło przewlekłych zaburzeń psychicznych z nawrotami manii, psychozy lub ciężkiej depresji. W trakcie średnio 16-letniej obserwacji 64% kobiet miało nawroty, a 36% pozostawało w remisji. Ryzyko nawrotu przy kolejnych ciążach wynosi około 50%, szczególnie u pacjentek z chorobą afektywną dwubiegunową, które wymagają szczególnej uwagi i monitorowania farmakoterapii.

Prognoza psychozy poporodowej

Rokowania krótkoterminowe
Rokowania długoterminowe
Ryzyko nawrotu w kolejnych ciążach
Związek z chorobą afektywną dwubiegunową
Czynniki predykcyjne i biomarkery
Genetyczne czynniki ryzyka
Implikacje kliniczne
Kolejne rozdziały

Prognoza psychozy poporodowej

Psychoza poporodowa jest poważnym zaburzeniem psychicznym występującym w okresie poporodowym u około 1 na 1000 kobiet po urodzeniu dziecka. Pomimo powszechnego użycia tego terminu, diagnoza ta nie jest formalnie uznawana w obecnych systemach klasyfikacji, takich jak Międzynarodowa Klasyfikacja Chorób, Dziesiąta Rewizja (ICD-10) czy Diagnostyczny i Statystyczny Podręcznik Zaburzeń Psychicznych, Piąta Edycja (DSM-5).¹ Prognoza dla pacjentek z psychozą poporodową jest kluczowa dla planowania długoterminowej opieki i leczenia farmakologicznego.²³

Rokowania krótkoterminowe

Psychoza poporodowa wymaga natychmiastowej interwencji medycznej i jest traktowana jako stan nagły w psychiatrii. Mimo poważnego charakteru zaburzenia, większość pacjentek dobrze odpowiada na leczenie, wykazując szybką poprawę i remisję objawów.⁴ Najcięższe objawy zazwyczaj utrzymują się od 2 do 12 tygodni, a pełny powrót do zdrowia może trwać od 6 do 12 miesięcy lub dłużej. Przy odpowiednim leczeniu i wsparciu, zdecydowana większość kobiet z psychozą poporodową osiąga pełną remisję.⁵

Badania pokazują, że krótszy czas trwania ostrego epizodu psychozy poporodowej wiąże się z lepszym rokowaniem. Psychoza poporodowa występująca po raz pierwszy ma lepsze rokowanie niż psychoza afektywna niezwiązana z okresem poporodowym.⁶

Rokowania długoterminowe

W perspektywie długoterminowej, badania wskazują na zróżnicowane rokowanie dla kobiet, które doświadczyły psychozy poporodowej. Prospektywne badanie kohortowe przeprowadzone na 106 kobietach wykazało, że ponad dwie trzecie pacjentek nie doświadczyło poważnych epizodów psychiatrycznych poza okresem poporodowym podczas obserwacji. Ogólny wskaźnik nawrotów zaburzeń nastroju/psychotycznych poza okresem poporodowym wynosił około 32%.⁷⁸⁹

Meta-analiza opublikowana w Journal of Clinical Psychiatry sugeruje jednak nieco inne wyniki. Według tego przeglądu:

43,5% (279/645) kobiet miało „izolowaną psychozę poporodową”, co oznacza, że albo doświadczyły jej jednorazowo bez nawrotów (36,1% całej próby), albo doświadczyły psychozy więcej niż raz, ale wyłącznie w okresach poporodowych (7,1% całej próby)¹⁰
Dla 56,7% kobiet (366/645) pierwszy epizod psychozy poporodowej był początkiem przewlekłego, poważnego zaburzenia psychicznego, z epizodami manii, psychozy lub ciężkiej depresji z objawami psychotycznymi występującymi poza okresem poporodowym¹¹
Z całej badanej próby, 64% (412/645) kobiet z pierwszym epizodem psychozy poporodowej doświadczyło nawrotu w jakimś momencie podczas okresu obserwacji (średnio 16 lat)¹²
36% nie miało nawrotów (95% CI, 32,3% do 39,7%) i pozostawało w remisji przez cały okres obserwacji, który wynosił średnio 16 lat¹³

Należy podkreślić, że wiele badań uwzględnionych w meta-analizie przeprowadzono w latach 70. i 80. XX wieku, co może ograniczać możliwość uogólnienia wyników do obecnych warunków leczenia.¹⁴

Ryzyko nawrotu w kolejnych ciążach

Kobiety, które doświadczyły psychozy poporodowej, mają zwiększone ryzyko nawrotu tego zaburzenia przy kolejnych ciążach. Według danych NHS, istnieje około 50% (1 na 2) szans na nawrót po przyszłej ciąży, jednak przy odpowiedniej opiece i właściwych interwencjach ryzyko to można zmniejszyć.¹⁵

Przebycie jednego epizodu psychozy poporodowej predysponuje pacjentkę do kolejnego epizodu przy przyszłej ciąży. Pacjentki z historią choroby afektywnej dwubiegunowej są szczególnie narażone na nawrót w czasie ciąży i po niej, dlatego powinny być dokładnie ocenione i poinformowane o ryzyku związanym z przyszłymi ciążami.¹⁶ Kobiety z zaburzeniami afektywnymi dwubiegunowymi częściej wymagają hospitalizacji psychiatrycznej w okresie połogu. Jeśli przerywają przyjmowanie leków, mogą doświadczać epizodów chorobowych już w trakcie ciąży.¹⁷

Związek z chorobą afektywną dwubiegunową

Istnieją znaczące dowody sugerujące fundamentalny związek między psychozą poporodową a chorobą afektywną dwubiegunową, które mogą stanowić dwie odrębne diagnozy w tym samym spektrum zaburzeń.¹⁸¹⁹²⁰ Po psychozie afektywnej w okresie poporodowym, która dotyka 20-50% kobiet, pacjentka ma 50-80% szans na kolejny poważny epizod psychiczny, często o charakterze dwubiegunowym.²¹

Biorąc pod uwagę, że 43,5% kobiet nie miało maniakalnych lub psychotycznych nawrotów poza okresem poporodowym, a 36% nie miało żadnych nawrotów, niektórzy badacze sugerują, że odrębna kategoria diagnostyczna psychozy poporodowej może być bardziej odpowiednia niż etykieta zaburzenia afektywnego dwubiegunowego.²²

Czynniki predykcyjne i biomarkery

Obecnie niewiele wiadomo o tym, które kobiety są szczególnie narażone na nawrót poza okresem poporodowym.²³²⁴ W badaniach nie zidentyfikowano istotnych klinicznych czynników predykcyjnych ryzyka wystąpienia ciężkich epizodów poza okresem poporodowym.²⁵²⁶²⁷

Niestety, obecnie nie są dostępne biomarkery, które mogłyby pomóc w podejmowaniu decyzji dotyczących długoterminowego leczenia. W praktyce klinicznej oznacza to, że długoterminowe monitorowanie jest wskazane u wszystkich kobiet z psychozą poporodową.²⁸²⁹

Genetyczne czynniki ryzyka

Najnowsze badania wskazują na potencjalną rolę genetycznych czynników związanych ze snem w ryzyku wystąpienia psychozy poporodowej. Wykazano, że wyższe wielogenowe wyniki ryzyka (PRS) dla bezsenności i krótkiego snu mają działanie ochronne przeciwko psychozie poporodowej.³⁰

Osoby z najniższym decylem PRS dla bezsenności miały około dwukrotnie większe ryzyko psychozy poporodowej niż osoby z najwyższym decylem³¹
Każdy wzrost o jedno odchylenie standardowe w PRS bezsenności był związany z ilorazem szans 0,718 dla psychozy poporodowej³²³³
Każdy wzrost o jedno odchylenie standardowe w PRS krótkiego snu był związany z ilorazem szans 0,674 dla psychozy poporodowej³⁴³⁵
Kobiety w najniższym decylu dla PRS krótkiego snu miały ponad dwukrotnie większe ryzyko psychozy poporodowej niż te w najwyższym decylu³⁶

Analizy sugerują, że włączenie PRS dla bezsenności i krótkiego snu wraz ze zmiennymi klinicznymi może poprawić dokładność przewidywania ryzyka psychozy poporodowej.³⁷³⁸ Nie znaleziono jednak istotnego związku między PRS długiego snu a ryzykiem psychozy poporodowej³⁹⁴⁰, ani między PRS efektywności snu a wystąpieniem psychozy poporodowej.⁴¹⁴²

Co ciekawe, badania nie wykazały istotnej różnicy w PRS dla choroby afektywnej dwubiegunowej lub schizofrenii u kobiet, które doświadczyły lub nie doświadczyły psychozy poporodowej po porodzie.⁴³⁴⁴ Wyniki te sugerują, że genetyczna podatność na zaburzenia snu odgrywa kluczową rolę w etiologii psychozy poporodowej, podkreślając znaczenie oceny indywidualnej historii snu w ocenie ryzyka psychiatrycznego w okresie okołoporodowym.⁴⁵⁴⁶

Implikacje kliniczne

Zrozumienie, które kobiety są narażone na ryzyko zaburzeń nastroju lub psychotycznych podczas obserwacji, a które mają podatność ograniczoną do okresu poporodowego, jest szczególnie ważne w kierowaniu decyzjami dotyczącymi leczenia, w tym długoterminowej farmakoterapii.⁴⁷⁴⁸ Zrozumienie prawdopodobieństwa nawrotu psychozy poporodowej ma istotne znaczenie dla analizy ryzyka i korzyści związanych z podtrzymującą farmakoterapią, a także przygotowaniem do kolejnych ciąż.⁴⁹

Psychoza poporodowa jest poważnym stanem psychicznym, który może prowadzić do niepożądanych skutków. Jeśli pozostanie nieleczona, może skutkować tragicznymi konsekwencjami, takimi jak samobójstwo lub zabójstwo dziecka. Jest to okres ogromnego stresu dla partnera i innych członków rodziny zaangażowanych w opiekę nad pacjentką i ma znaczące implikacje psychospołeczne.⁵⁰

Kolejne rozdziały

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Materiały źródłowe

#1 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. Further research is needed to reproduce these numbers in the current treatment setting. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period.
#2 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis. […] For the remaining women, postpartum psychosis was part of a mood or psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors of a woman’s risk of severe episodes outside the postpartum period were found.
#3 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period. […] Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. […] In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis.
#4 Postpartum Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544304/
Postpartum psychosis is a severe mental crisis that warrants immediate medical attention. Although considered a psychiatric emergency, most patients respond to treatment and demonstrate fast recovery and remission. However, having one episode of postpartum psychosis predisposes the patient to another episode with a future pregnancy. Patients with a history of bipolar disorder are predisposed to developing a relapse during and after pregnancy and should be carefully evaluated and counseled regarding the risk in future pregnancies. […] Postpartum psychosis is a rare occurrence but may lead to undesirable outcomes. The proper identification of risk markers would enhance the ability to prevent and manage the condition. If left untreated, it can result in tragic consequences like suicide or filicide. It is a period of tremendous stress for the partner and other family members involved in taking care of the patient and has notable psychosocial implications.
#5 Postpartum psychosis – NHS
https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/
Postpartum psychosis is a serious mental health illness that can affect someone soon after having a baby. It affects around 1 in 1,000 mothers after giving birth. […] Postpartum psychosis is a serious mental illness that should be treated as a medical emergency. It can get worse rapidly and the illness can risk the safety of the mother and baby. […] Most people with postpartum psychosis make a full recovery as long as they receive the right treatment. […] The most severe symptoms tend to last 2 to 12 weeks, and it can take 6 to 12 months or more to recover completely from the condition. But with treatment and the right support, most people with postpartum psychosis do make a full recovery. […] Although there is about a 1 in 2 chance you will have another episode after a future pregnancy, you should be able to get help quickly with the right care and the risks can be reduced with appropriate interventions.
#6 SciELO Brazil – Puerperal psychosis: an update Puerperal psychosis: an update
https://www.scielo.br/j/ramb/a/Kv99pPwQGYyhj4Pdhp5BgrQ/
Postpartum psychosis increases infanticide and suicide. Shorter acute postpartum psychosis episodes had a better prognosis. First-onset PP had a better outcome than non-postpartum affective psychosis. Some women have severe, lasting mental disorders following PP. After postpartum affective psychosis, which affects 20-50% of women, she has a 50-80% chance of another significant mental episode, frequently a bipolar one.
#7 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was~32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#8 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. […] The overall recurrence rate of mood/psychotic episodes outside the postpartum period was~32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. […] For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. […] No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#9 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women. – Document – Gale Academic OneFile
https://go.gale.com/ps/i.do?id=GALE%7CA680479013&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=21947511&p=AONE&sw=w
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. […] The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. […] For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. […] No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#10 Long-Term Outcomes of Postpartum Psychosis: What is the Risk of Recurrence? – MGH Center for Women’s Mental Health
https://womensmentalhealth.org/posts/recurrence-of-postpartum-psychosis/
Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in fewer than one out of every 1000 women after childbirth. Many women who have suffered from postpartum psychosis (PP) wonder about their long term prognosis. Will they have another psychotic episode if they have another child? Will they have another episode if they taper off their medication? Many of these questions are still unanswered, although we do know that, in women who have experienced PP, recurrent episodes can be effectively prevented. […] A recent systematic review and meta-analysis published in the Journal of Clinical Psychiatry reviews the probability of recurrent psychiatric illness following an episode of PP. […] In estimating risk of recurrence, they observed the following: 43.5% (279/645) of women had âisolated postpartum psychosis,â meaning either they experienced PP once and had no recurrence (36.1% of total sample), or experienced psychosis more than once but exclusively during postpartum periods (7.1% of total sample).
#11 Long-Term Outcomes of Postpartum Psychosis: What is the Risk of Recurrence? – MGH Center for Women’s Mental Health
https://womensmentalhealth.org/posts/recurrence-of-postpartum-psychosis/
For 56.7% of women (366/645) their first postpartum psychosis episode was the onset of a lifelong severe psychiatric disorder, with episodes of mania, psychosis, or major depression with psychosis occurring outside of the postpartum period. […] Of the overall sample, 64% (412/645) women with first-onset PP experienced a recurrence at some point during the follow up period (mean of 16 years). […] 36% had no recurrence, (95% CI, 32.3% to 39.7%) and remained in remission for duration of follow up which was a mean of 16 years. […] Given that 43.5% of women had no manic or psychotic recurrence outside of the postpartum period, and 36% had no recurrence at all, a distinct diagnostic category of postpartum psychosis may be more appropriate than a label of bipolar disorder. […] This review indicates that for the majority (56.5%) of women who experienced first-onset postpartum psychosis, they later experienced a severe non-postpartum recurrence. […] Understanding the likelihood of PP recurrence is important to the risk-benefit analysis of maintenance pharmacotherapy as well as preparing for subsequent pregnancies.
#12 Long-Term Outcomes of Postpartum Psychosis: What is the Risk of Recurrence? – MGH Center for Women’s Mental Health
https://womensmentalhealth.org/posts/recurrence-of-postpartum-psychosis/
For 56.7% of women (366/645) their first postpartum psychosis episode was the onset of a lifelong severe psychiatric disorder, with episodes of mania, psychosis, or major depression with psychosis occurring outside of the postpartum period. […] Of the overall sample, 64% (412/645) women with first-onset PP experienced a recurrence at some point during the follow up period (mean of 16 years). […] 36% had no recurrence, (95% CI, 32.3% to 39.7%) and remained in remission for duration of follow up which was a mean of 16 years. […] Given that 43.5% of women had no manic or psychotic recurrence outside of the postpartum period, and 36% had no recurrence at all, a distinct diagnostic category of postpartum psychosis may be more appropriate than a label of bipolar disorder. […] This review indicates that for the majority (56.5%) of women who experienced first-onset postpartum psychosis, they later experienced a severe non-postpartum recurrence. […] Understanding the likelihood of PP recurrence is important to the risk-benefit analysis of maintenance pharmacotherapy as well as preparing for subsequent pregnancies.
#13 Long-Term Outcomes of Postpartum Psychosis: What is the Risk of Recurrence? – MGH Center for Women’s Mental Health
https://womensmentalhealth.org/posts/recurrence-of-postpartum-psychosis/
For 56.7% of women (366/645) their first postpartum psychosis episode was the onset of a lifelong severe psychiatric disorder, with episodes of mania, psychosis, or major depression with psychosis occurring outside of the postpartum period. […] Of the overall sample, 64% (412/645) women with first-onset PP experienced a recurrence at some point during the follow up period (mean of 16 years). […] 36% had no recurrence, (95% CI, 32.3% to 39.7%) and remained in remission for duration of follow up which was a mean of 16 years. […] Given that 43.5% of women had no manic or psychotic recurrence outside of the postpartum period, and 36% had no recurrence at all, a distinct diagnostic category of postpartum psychosis may be more appropriate than a label of bipolar disorder. […] This review indicates that for the majority (56.5%) of women who experienced first-onset postpartum psychosis, they later experienced a severe non-postpartum recurrence. […] Understanding the likelihood of PP recurrence is important to the risk-benefit analysis of maintenance pharmacotherapy as well as preparing for subsequent pregnancies.
#14 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. Further research is needed to reproduce these numbers in the current treatment setting. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period.
#15 Postpartum psychosis – NHS
https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/
Postpartum psychosis is a serious mental health illness that can affect someone soon after having a baby. It affects around 1 in 1,000 mothers after giving birth. […] Postpartum psychosis is a serious mental illness that should be treated as a medical emergency. It can get worse rapidly and the illness can risk the safety of the mother and baby. […] Most people with postpartum psychosis make a full recovery as long as they receive the right treatment. […] The most severe symptoms tend to last 2 to 12 weeks, and it can take 6 to 12 months or more to recover completely from the condition. But with treatment and the right support, most people with postpartum psychosis do make a full recovery. […] Although there is about a 1 in 2 chance you will have another episode after a future pregnancy, you should be able to get help quickly with the right care and the risks can be reduced with appropriate interventions.
#16 Postpartum Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544304/
Postpartum psychosis is a severe mental crisis that warrants immediate medical attention. Although considered a psychiatric emergency, most patients respond to treatment and demonstrate fast recovery and remission. However, having one episode of postpartum psychosis predisposes the patient to another episode with a future pregnancy. Patients with a history of bipolar disorder are predisposed to developing a relapse during and after pregnancy and should be carefully evaluated and counseled regarding the risk in future pregnancies. […] Postpartum psychosis is a rare occurrence but may lead to undesirable outcomes. The proper identification of risk markers would enhance the ability to prevent and manage the condition. If left untreated, it can result in tragic consequences like suicide or filicide. It is a period of tremendous stress for the partner and other family members involved in taking care of the patient and has notable psychosocial implications.
#17 SciELO Brazil – Puerperal psychosis: an update Puerperal psychosis: an update
https://www.scielo.br/j/ramb/a/Kv99pPwQGYyhj4Pdhp5BgrQ/
There is a significantly higher risk of postpartum depression. New-onset affective psychosis is also rare during pregnancy and postpartum. For women with mental illness, the postpartum period increases the chance of recurrence and first-onset affective psychosis. Bipolar women are more likely to need puerperal psychiatric hospitalization. If they stop taking their medication, bipolar women may have episodes during pregnancy. […] Symptoms typically occur days or weeks before mental health institution admission. Insomnia, mood fluctuations, and irritability precede mania, depression, or a mixed state in postpartum psychosis. Despite fast mood swings, postpartum psychosis symptoms are generally different from those of bipolar disease. Mood-incongruent birth fantasies are common. Disorganized behavior and obsessive thoughts about the child are also common.
#18 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was~32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#19 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. […] The overall recurrence rate of mood/psychotic episodes outside the postpartum period was~32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. […] For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. […] No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#20 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women. – Document – Gale Academic OneFile
https://go.gale.com/ps/i.do?id=GALE%7CA680479013&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=21947511&p=AONE&sw=w
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. […] The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. […] For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. […] No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#21 SciELO Brazil – Puerperal psychosis: an update Puerperal psychosis: an update
https://www.scielo.br/j/ramb/a/Kv99pPwQGYyhj4Pdhp5BgrQ/
Postpartum psychosis increases infanticide and suicide. Shorter acute postpartum psychosis episodes had a better prognosis. First-onset PP had a better outcome than non-postpartum affective psychosis. Some women have severe, lasting mental disorders following PP. After postpartum affective psychosis, which affects 20-50% of women, she has a 50-80% chance of another significant mental episode, frequently a bipolar one.
#22 Long-Term Outcomes of Postpartum Psychosis: What is the Risk of Recurrence? – MGH Center for Women’s Mental Health
https://womensmentalhealth.org/posts/recurrence-of-postpartum-psychosis/
For 56.7% of women (366/645) their first postpartum psychosis episode was the onset of a lifelong severe psychiatric disorder, with episodes of mania, psychosis, or major depression with psychosis occurring outside of the postpartum period. […] Of the overall sample, 64% (412/645) women with first-onset PP experienced a recurrence at some point during the follow up period (mean of 16 years). […] 36% had no recurrence, (95% CI, 32.3% to 39.7%) and remained in remission for duration of follow up which was a mean of 16 years. […] Given that 43.5% of women had no manic or psychotic recurrence outside of the postpartum period, and 36% had no recurrence at all, a distinct diagnostic category of postpartum psychosis may be more appropriate than a label of bipolar disorder. […] This review indicates that for the majority (56.5%) of women who experienced first-onset postpartum psychosis, they later experienced a severe non-postpartum recurrence. […] Understanding the likelihood of PP recurrence is important to the risk-benefit analysis of maintenance pharmacotherapy as well as preparing for subsequent pregnancies.
#23 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. Further research is needed to reproduce these numbers in the current treatment setting. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period.
#24 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period. […] Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. […] In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis.
#25 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was~32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#26 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. […] The overall recurrence rate of mood/psychotic episodes outside the postpartum period was~32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. […] For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. […] No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#27 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women. – Document – Gale Academic OneFile
https://go.gale.com/ps/i.do?id=GALE%7CA680479013&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=21947511&p=AONE&sw=w
Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. […] The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%. […] For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. […] For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. […] No clinical predictors for risk of severe episodes outside the postpartum period emerged. […] Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.
#28 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis. […] For the remaining women, postpartum psychosis was part of a mood or psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors of a woman’s risk of severe episodes outside the postpartum period were found.
#29 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period. […] Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. […] In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis.
#30 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Postpartum Psychosis (PP) is a severe and understudied perinatal mental illness which disproportionately affects women with bipolar disorder (BD). […] Higher PRS for insomnia and short sleep were protective against PP. […] Individuals in the lowest decile for insomnia PRS had approximately double the risk of PP than individuals in the highest decile. […] Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP. […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP. […] Women in the bottom decile for short sleep PRS had over twice the risk of PP than those in the top decile.
#31 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Postpartum Psychosis (PP) is a severe and understudied perinatal mental illness which disproportionately affects women with bipolar disorder (BD). […] Higher PRS for insomnia and short sleep were protective against PP. […] Individuals in the lowest decile for insomnia PRS had approximately double the risk of PP than individuals in the highest decile. […] Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP. […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP. […] Women in the bottom decile for short sleep PRS had over twice the risk of PP than those in the top decile.
#32 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Postpartum Psychosis (PP) is a severe and understudied perinatal mental illness which disproportionately affects women with bipolar disorder (BD). […] Higher PRS for insomnia and short sleep were protective against PP. […] Individuals in the lowest decile for insomnia PRS had approximately double the risk of PP than individuals in the highest decile. […] Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP. […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP. […] Women in the bottom decile for short sleep PRS had over twice the risk of PP than those in the top decile.
#33 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP (95% CI 0.575-0.897; p=3.5 10 3). […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP (95% CI 0.535-0.849; p=7.94104). […] Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk.
#34 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Postpartum Psychosis (PP) is a severe and understudied perinatal mental illness which disproportionately affects women with bipolar disorder (BD). […] Higher PRS for insomnia and short sleep were protective against PP. […] Individuals in the lowest decile for insomnia PRS had approximately double the risk of PP than individuals in the highest decile. […] Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP. […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP. […] Women in the bottom decile for short sleep PRS had over twice the risk of PP than those in the top decile.
#35 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP (95% CI 0.575-0.897; p=3.5 10 3). […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP (95% CI 0.535-0.849; p=7.94104). […] Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk.
#36 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Postpartum Psychosis (PP) is a severe and understudied perinatal mental illness which disproportionately affects women with bipolar disorder (BD). […] Higher PRS for insomnia and short sleep were protective against PP. […] Individuals in the lowest decile for insomnia PRS had approximately double the risk of PP than individuals in the highest decile. […] Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP. […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP. […] Women in the bottom decile for short sleep PRS had over twice the risk of PP than those in the top decile.
#37 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] Our MR analyses do not support a causal relationship between insomnia and PP or short sleep and PP. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk. […] Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#38 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP (95% CI 0.575-0.897; p=3.5 10 3). […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP (95% CI 0.535-0.849; p=7.94104). […] Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk.
#39 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] Our MR analyses do not support a causal relationship between insomnia and PP or short sleep and PP. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk. […] Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#40 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Individuals with lower insomnia PRS were found to be at increased risk of PP than individuals with higher PRS. […] Each one standard deviation increase in insomnia PRS was associated with an odds ratio of 0.718 for PP (95% CI 0.575-0.897; p=3.5 10 3). […] Each one standard deviation increase in short sleep PRS was associated with an odds ratio of 0.674 for PP (95% CI 0.535-0.849; p=7.94104). […] Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk.
#41 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] Our MR analyses do not support a causal relationship between insomnia and PP or short sleep and PP. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk. […] Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#42 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#43 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] Our MR analyses do not support a causal relationship between insomnia and PP or short sleep and PP. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk. […] Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#44 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#45 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full-text
Our findings support previous work indicating that PRS of sleep phenotypes may contribute to risk stratification in BD outside the perinatal period. […] Our analyses suggest that incorporating PRS for insomnia and short sleep alongside clinical variables can improve the accuracy of PP risk prediction. […] Our MR analyses do not support a causal relationship between insomnia and PP or short sleep and PP. […] We did not find evidence to suggest a significant association between long sleep PRS and PP risk. […] Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#46 Postpartum Psychosis: could chronic insomnia or short sleep be protective? | medRxiv
https://www.medrxiv.org/content/10.1101/2024.12.13.24319005v1.full
Our study did not identify an association between sleep efficiency PRS and PP outcome. […] Despite our study having adequate power to detect a significant association, we found no significant difference in BD PRS or schizophrenia PRS in women who did and who did not develop PP following childbirth. […] These findings suggest that genetic vulnerability to sleep disturbance plays a critical role in the aetiology of PP, highlighting the importance of assessing individual sleep history in perinatal psychiatric risk.
#47 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women | International Journal of Bipolar Disorders | Full Text
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-021-00236-2
Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis. […] For the remaining women, postpartum psychosis was part of a mood or psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors of a woman’s risk of severe episodes outside the postpartum period were found.
#48 Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
https://pmc.ncbi.nlm.nih.gov/articles/PMC8554899/
Despite the widespread use of the term postpartum psychosis, this diagnosis is not recognized in current classification systems, including the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). […] It is important to note that most studies included in the meta-analysis were performed in the 1970s and 1980s, limiting the generalizability of the results. […] Currently, little is known about which women are specifically at risk for recurrence outside the postpartum period. […] However, these studies were small and conducted retrospectively. […] We did not find significant predictors of recurrence outside the postpartum period. […] Understanding who is at risk of a mood or psychotic disorder during follow-up, and whose vulnerability is limited to the postpartum period, is particularly important in guiding treatment decisions including long-term pharmacotherapy. […] Unfortunately, no biomarkers are currently available to help guide these decisions. […] In clinical practice, this means that long-term monitoring is warranted for everyone with postpartum psychosis.
#49 Long-Term Outcomes of Postpartum Psychosis: What is the Risk of Recurrence? – MGH Center for Women’s Mental Health
https://womensmentalhealth.org/posts/recurrence-of-postpartum-psychosis/
For 56.7% of women (366/645) their first postpartum psychosis episode was the onset of a lifelong severe psychiatric disorder, with episodes of mania, psychosis, or major depression with psychosis occurring outside of the postpartum period. […] Of the overall sample, 64% (412/645) women with first-onset PP experienced a recurrence at some point during the follow up period (mean of 16 years). […] 36% had no recurrence, (95% CI, 32.3% to 39.7%) and remained in remission for duration of follow up which was a mean of 16 years. […] Given that 43.5% of women had no manic or psychotic recurrence outside of the postpartum period, and 36% had no recurrence at all, a distinct diagnostic category of postpartum psychosis may be more appropriate than a label of bipolar disorder. […] This review indicates that for the majority (56.5%) of women who experienced first-onset postpartum psychosis, they later experienced a severe non-postpartum recurrence. […] Understanding the likelihood of PP recurrence is important to the risk-benefit analysis of maintenance pharmacotherapy as well as preparing for subsequent pregnancies.
#50 Postpartum Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544304/
Postpartum psychosis is a severe mental crisis that warrants immediate medical attention. Although considered a psychiatric emergency, most patients respond to treatment and demonstrate fast recovery and remission. However, having one episode of postpartum psychosis predisposes the patient to another episode with a future pregnancy. Patients with a history of bipolar disorder are predisposed to developing a relapse during and after pregnancy and should be carefully evaluated and counseled regarding the risk in future pregnancies. […] Postpartum psychosis is a rare occurrence but may lead to undesirable outcomes. The proper identification of risk markers would enhance the ability to prevent and manage the condition. If left untreated, it can result in tragic consequences like suicide or filicide. It is a period of tremendous stress for the partner and other family members involved in taking care of the patient and has notable psychosocial implications.