Blackmore Emma Robertson, Rubinow David R, O'Connor Thomas G, Liu Xiang, Tang Wan, Craddock Nick, Jones Ian
Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY.
Bipolar Disord. 2013 Jun;15(4):394-404. doi: 10.1111/bdi.12071. Epub 2013 May 7.
Women who experience postpartum psychosis (PP) seek guidance on further pregnancies and risk of illness; however, empirical data are limited. This study describes reproductive and mental health outcomes in women diagnosed with PP and examines clinical risk factors as predictors of further illness.
A retrospective cohort design was used; 116 women who experienced episodes of mania or depression with psychotic features within six weeks of childbirth were recruited. All subjects underwent clinical diagnostic interviews and medical case notes were reviewed.
Only 33% of women had an antecedent history, of which 34% had bipolar disorder and 55% unipolar depression. Only 58% of those with PP in their first pregnancy had a subsequent pregnancy, and 18% of marriages ended following the PP episode. Clinical presentation at the time of initial episode did not influence the timing of the onset of symptoms, treatment, or recovery. Although 86% of patients received treatment within 30 days of onset, 26% of women reported ongoing symptoms at a year after delivery. The recurrence rate of PP was 54.4%; a longer duration of the index episode (p < 0.05) and longer latency between the index PP and next pregnancy predicted a subsequent PP. The rate of subsequent non-puerperal episodes was 69%, and all these episodes were bipolar.
Postpartum psychosis is difficult to predict in women with no antecedent history and is associated with a high rate of subsequent puerperal and non-puerperal illness. Risk of further illness needs to be conveyed in order to allow fully informed decisions to be made regarding future pregnancies.
经历产后精神病（PP）的女性会寻求关于再次怀孕及患病风险的指导；然而，实证数据有限。本研究描述了被诊断为PP的女性的生殖和心理健康结局，并检查临床风险因素作为未来患病的预测指标。
采用回顾性队列设计；招募了116名在分娩后六周内经历过伴有精神病特征的躁狂或抑郁发作的女性。所有受试者均接受了临床诊断访谈，并查阅了医疗病历。
只有33%的女性有既往病史，其中34%患有双相情感障碍，55%患有单相抑郁症。首次怀孕时患有PP的女性中，只有58%有后续怀孕，18%的婚姻在PP发作后结束。首次发作时的临床表现并未影响症状发作、治疗或康复的时间。尽管86%的患者在发病后30天内接受了治疗，但26%的女性在分娩后一年仍报告有持续症状。PP的复发率为54.4%；首次发作持续时间较长（p < 0.05）以及首次PP发作与下次怀孕之间的间隔时间较长预示着会再次发生PP。后续非产褥期发作的发生率为69%，所有这些发作均为双相情感障碍。
无前驱病史的女性产后精神病难以预测，且与后续产褥期和非产褥期疾病的高发生率相关。需要告知未来患病的风险，以便就未来怀孕做出充分知情的决定。
