Psychological Medicine, University of Worcester, UK.
National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, 3.06, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
Psychiatry Res. 2020 Feb;284:112748. doi: 10.1016/j.psychres.2020.112748. Epub 2020 Jan 2.
The relationship of postpartum mania to episodes of mania occurring outside the perinatal period among women with bipolar disorder remains controversial. Previous studies have used between-subjects designs to compare the clinical presentations of these episodes meaning the differences, in part, may reflect between-group differences. To overcome this we have undertaken within-subject comparisons of the symptom profile of postpartum and non-postpartum manic episodes in 50 women with DSM-IV bipolar I disorder. For each woman detailed symptom information on a postpartum episode of mania and a comparison non-postpartum manic episode was collected. The occurrence of manic, psychotic and depressive symptoms in these episodes were compared. Postpartum manic episodes had a significantly higher incidence of perplexity and excessive self-reproach. Classic manic symptoms, specifically pressured speech and increased sociability, were significantly less frequent in postpartum manic episodes. Overall there were significantly fewer manic symptoms and significantly more depressive symptoms in the postpartum episodes than in the non-postpartum episodes. The mixed presentation of postpartum manic episodes suggests childbirth may act as a pathoplastic trigger in women with bipolar disorder. The differences in symptom profiles suggests further research is warranted into whether differences in treatment response exist among women experiencing postpartum and non-postpartum manic episodes.
产后躁狂与双相情感障碍女性围产期外躁狂发作之间的关系仍存在争议。先前的研究使用了组间设计来比较这些发作的临床表现，这意味着部分差异可能反映了组间差异。为了克服这一点，我们对 50 名患有 DSM-IV 双相情感障碍 I 型的女性的产后和非产后躁狂发作的症状谱进行了个体内比较。对于每位女性，我们都收集了产后躁狂发作和比较非产后躁狂发作的详细症状信息。比较了这些发作中躁狂、精神病和抑郁症状的发生情况。产后躁狂发作的困惑和过度自责明显更为常见。经典的躁狂症状，特别是语速加快和社交能力增强，在产后躁狂发作中明显较少出现。总体而言，产后发作的躁狂症状明显较少，抑郁症状明显较多。产后躁狂发作的混合表现表明，分娩可能是双相情感障碍女性的一种病理触发因素。症状谱的差异表明，需要进一步研究产后和非产后躁狂发作的女性在治疗反应方面是否存在差异。
