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心理和社会因素对既往有情感障碍病史女性产后精神病性和非精神病性复发的影响

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

作者信息

Marks M N, Wieck A, Checkley S A, Kumar R

机构信息

Department of Psychiatry, Institute of Psychiatry, London, UK.

出版信息

J Affect Disord. 1992 Apr;24(4):253-63. doi: 10.1016/0165-0327(92)90110-r.

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.

摘要

对26名有双相情感障碍或分裂情感性障碍病史的女性、17名有重度抑郁症病史的女性以及45名无精神病史的对照女性在妊娠第9个月进行了特定心理社会指标评估。从此时到分娩,没有受试者符合研究诊断标准(RDC)所定义的“病例”。产后6个月内,22名(51%)有精神病史的女性被归类为复发(RDC病例)。12名女性出现了精神病(躁狂、轻躁狂或类精神分裂症躁狂),这些疾病仅发生在有情感性或分裂情感性精神病病史的女性中,而另外10名产后抑郁的女性同样来自有精神病病史的女性(N = 5)和有重度抑郁症病史的女性(N = 5)。3名(7%)对照女性也出现了产后非精神病性抑郁障碍。多变量分析表明,与产后非精神病性情感障碍不同,不同的心理社会因素导致了产后情感性和分裂情感性精神病的复发。产前神经质和发病前的严重生活事件可预测非精神病性疾病。产后精神病复发可通过躁狂、轻躁狂或类精神分裂症躁狂病史、近期的精神病住院治疗以及报告的婚姻困难来预测。在这个女性样本中,生活压力导致了产后抑郁,而不论受试者的既往病史如何,情感性或分裂情感性精神病的高复发率(47%)可能主要反映了一种预先存在的生理或心理易感性,这种易感性可能因婚姻困难而加剧或导致了婚姻困难。

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