Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, LondonSE5 8AF, United Kingdom.
South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Eur Psychiatry. 2021 Mar 19;64(1):e26. doi: 10.1192/j.eurpsy.2021.18.
Symptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period.
Data were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with SMI (positive, negative, disorganization, mania, depression, and catatonia) recorded in clinical notes 2 years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalization during pregnancy and 3 months postpartum.
Seventy-six women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganization symptoms showed a positive association at borderline significance with relapse during pregnancy (adjusted odds ratio [aOR] = 1.36; 95% confidence interval [CI] = 0.99-1.87 per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62-0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganization (1.84; 1.22-2.76), positive (1.50; 1.07-2.11), and manic (1.48; 1.03-2.11) symptoms were associated with relapse during pregnancy, and disorganization (1.54; 1.08-2.20) symptom domains were associated with relapse postpartum.
Positive, disorganization, and manic symptoms recorded in the 2 years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterization of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.
症状可能比诊断更能作为精神疾病的预后标志物。我们旨在研究先前患有严重精神疾病（精神病和双相障碍）的女性的症状领域，以预测围产期的复发风险。
数据来自伦敦南部一家大型精神保健服务提供商的 399 名患有严重精神疾病的孕妇的电子健康记录。使用自然语言处理算法从文本中提取数据，从临床记录中识别出与六种典型的精神疾病相关的症状领域（阳性、阴性、紊乱、躁狂、抑郁和紧张症），并研究与怀孕期间和产后 3 个月住院之间的关联。
76 名女性（19%）在怀孕期间复发，107 名女性（27%）在产后复发。调整协变量后，紊乱症状与怀孕期间的复发呈正相关（调整后的优势比[aOR]每增加一个症状单位为 1.36；95%置信区间[CI]为 0.99-1.87），抑郁症状与产后复发呈负相关（0.78；0.62-0.98）。将样本限制在每个症状领域至少记录有一个症状的女性中，更高的紊乱（1.84；1.22-2.76）、阳性（1.50；1.07-2.11）和躁狂（1.48；1.03-2.11）症状与怀孕期间的复发相关，紊乱（1.54；1.08-2.20）症状领域与产后复发相关。
在怀孕前 2 年记录的阳性、紊乱和躁狂症状与怀孕期间和产后复发风险增加有关。从文本字段中描述常规健康记录的方法相对可转移，可以帮助预测风险模型。
