Department of Psychiatry, Erasmus MC, s'Gravendijkwal 230, Rotterdam, the Netherlands.
J Clin Psychiatry. 2011 Nov;72(11):1531-7. doi: 10.4088/JCP.10m06648. Epub 2011 Aug 23.
To prospectively characterize a cohort of patients for whom first lifetime episode of psychosis occurs in the postpartum period.
Included in the study were 51 women admitted to an inpatient facility for postpartum psychosis and a population-based control group (n = 6,969). All patients received naturalistic treatment using the sequential addition of benzodiazepines, antipsychotics, and lithium. A clinician-administered questionnaire and parallel history provided information about obstetric history, pregnancy, delivery, breastfeeding, neonatal outcomes, and onset of the disease. Clinical remission was defined as the absence of psychotic, manic, and depressive symptoms for at least 1 week. The primary outcome measure was the Clinical Global Impressions-Severity scale. The study was conducted from 2005 to 2009.
Compared to the general population sample, women with postpartum psychosis had a significantly higher incidence of primiparity (OR = 2.90; 95% CI, 1.49-5.67) but had no significant differences in delivery-related, lactational, or neonatal-related risk factors. The median onset of psychiatric symptoms occurred at 8 days' postpartum (interquartile range [IQR], 5-14), and median duration of episode was 40 days (IQR, 23-69). Patients with prominent depressive symptoms had a significantly later onset (P = .01) of psychosis and a longer duration of episode (P < .01) than patients without depressive symptoms. Psychotic symptoms were mood-incongruent in 64.7% of patients.
In contrast to other findings related to postpartum psychosis in bipolar patients, no delivery-related, neonatal-related, or lactational risk factors could be identified. Further, our findings of a delayed onset and mood incongruence of postpartum psychotic symptoms markedly contrasts with that of patients with a previous history of bipolar disorder. These results suggest that women with psychosis limited to the postpartum period might have a distinct risk profile and phenomenology.
前瞻性描述一组首次出现产后精神病发作的患者人群。
本研究纳入了 51 名因产后精神病而入住住院病房的女性患者和一个基于人群的对照组（n=6969）。所有患者均接受苯二氮䓬类药物、抗精神病药物和锂盐的序贯加用治疗。使用临床医生管理的问卷和平行病史记录提供关于产科史、妊娠、分娩、母乳喂养、新生儿结局和疾病发病情况的信息。临床缓解定义为至少 1 周无精神病、躁狂和抑郁症状。主要结局测量指标为临床总体印象严重程度量表。该研究于 2005 年至 2009 年进行。
与一般人群样本相比，产后精神病患者的初产妇比例明显更高（OR=2.90；95%CI，1.49-5.67），但在与分娩相关、哺乳期或新生儿相关的风险因素方面没有显著差异。精神病症状的中位发病时间为产后 8 天（四分位间距[IQR]，5-14），中位发作持续时间为 40 天（IQR，23-69）。有明显抑郁症状的患者精神病发作的发病时间明显较晚（P=0.01），发作持续时间也更长（P<0.01）。64.7%的患者精神病症状与心境不一致。
与其他与双相患者产后精神病相关的发现不同，我们没有发现与分娩、新生儿或哺乳期相关的风险因素。此外，我们发现产后精神病症状的发病时间较晚且与心境不一致，这与有既往双相障碍病史的患者明显不同。这些结果表明，仅在产后出现精神病的女性可能具有独特的风险特征和表现。
