Munk-Olsen Trine, Laursen Thomas Munk, Meltzer-Brody Samantha, Mortensen Preben Bo, Jones Ian
National Centre for Register-Based Research, Aarhus University, Denmark.
Arch Gen Psychiatry. 2012 Apr;69(4):428-34. doi: 10.1001/archgenpsychiatry.2011.157. Epub 2011 Dec 5.
Childbirth has an important influence on the onset and course of bipolar affective disorder, and it is well established that there may be a delay of many years before receiving a diagnosis of bipolar disorder following an initial episode of psychiatric illness.
To study to what extent psychiatric disorders with postpartum onset are early manifestations of an underlying bipolar affective disorder.
Survival analyses were performed in a register-based cohort study linking information from the Danish Civil Registration System and the Danish Psychiatric Central Register.
Denmark.
A total of 120,378 women with a first-time psychiatric inpatient or outpatient contact with any type of mental disorder excluding bipolar affective disorder.
Each woman was followed up individually from the day of discharge, with the outcome of interest being an inpatient or outpatient contact during the follow-up period with a first-time diagnosis of bipolar affective disorder.
A total of 3062 women were readmitted or had an outpatient contact with bipolar affective disorder diagnoses. A postpartum onset of symptoms within 0 to 14 days after delivery predicted subsequent conversion to bipolar disorder (relative risk = 4.26; 95% CI =3.11-5.85). Approximately 14% of women with first-time psychiatric contacts during the first postpartum month converted to a bipolar diagnosis within the 15-year follow-up period compared with 4% of women with a first psychiatric contact not related to childbirth. Postpartum inpatient admissions were also associated with higher conversion rates to bipolar disorder than outpatient contacts (relative risk = 2.16; 95% CI = 1.27-3.66).
A psychiatric episode in the immediate postpartum period significantly predicted conversion to bipolar affective disorder during the follow-up period. Results indicate that the presentation of mental illness in the early postpartum period is a marker of possible underlying bipolarity.
分娩对双相情感障碍的发病及病程有重要影响，且众所周知，在首次出现精神疾病发作后，可能会延迟许多年才被诊断为双相情感障碍。
研究产后发病的精神障碍在多大程度上是潜在双相情感障碍的早期表现。
在一项基于登记的队列研究中进行生存分析，该研究将丹麦民事登记系统和丹麦精神病学中央登记处的信息相联系。
丹麦。
共有120378名首次因任何类型精神障碍（不包括双相情感障碍）而进行精神科住院或门诊治疗的女性。
从出院之日起对每位女性进行单独随访，感兴趣的结果是在随访期间首次诊断为双相情感障碍的住院或门诊治疗。
共有3062名女性再次入院或因双相情感障碍诊断进行门诊治疗。产后0至14天内出现症状预示着随后会转变为双相情感障碍（相对风险=4.26；95%置信区间=3.11 - 5.85）。在产后第一个月首次进行精神科治疗的女性中，约14%在15年随访期内转变为双相情感障碍诊断，而首次精神科治疗与分娩无关的女性中这一比例为4%。产后住院治疗转变为双相情感障碍的比率也高于门诊治疗（相对风险=2.16；95%置信区间=1.27 - 3.66）。
产后立即出现的精神发作显著预示着随访期间会转变为双相情感障碍。结果表明，产后早期出现的精神疾病是潜在双相性的一个标志。
