Clinical course of illness in women with early onset puerperal psychosis: a 12-year follow-up study

Hans-Peter Kapfhammer, Hans‐Peter Kapfhammer, Eva Z. Reininghaus, Werner Fitz, Peter Lange
The Journal of clinical psychiatry · 2014 · vol. 75(10) , pp. 1096–1104 · doi:10.4088/jcp.13m08769 · PMID:25373118 · W2006134514
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This 12-year follow-up study of early-onset puerperal psychosis found that brief psychosis strongly links to bipolar disorder and relapse risk is high, while gynecologic variables did not significantly discriminate between patient groups.

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This retrospective study followed 90 women for a mean of 12 years after experiencing early onset puerperal psychosis to assess long-term clinical outcomes and diagnostic stability. The researchers found that initial episodes often evolved into bipolar affective disorder, with a high overall risk of psychotic relapse during subsequent pregnancies or other life events. While gynecologic variables such as postpartum blues and premenstrual tension were collected, they did not significantly discriminate between patient groups, though hormonal susceptibility was discussed as a potential factor. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

OBJECTIVE: To complete a follow-up analysis at a mean of 12 years after patients had presented with an early onset puerperal psychotic index episode. METHOD: A retrospective design was used. Patients with puerperal psychosis and onset within 4 weeks after childbirth who had been referred to the Psychiatric Department of the Ludwig Maximilian University of Munich, Munich, Germany, between 1975 and 1995 (maximum: 24 years, minimum: 7 years) were followed up after a mean of 12 years post index episode. Ninety patients were included in the study. Before the index episode, 35 of the patients had previous nonpuerperal psychoses, while 55 patients presented their index episode as the first manifestation of a psychotic illness. Diagnostic evaluation at follow-up was performed by the Structured Clinical Interview for DSM-IV Axis I Disorders according to DSM-IV-TR. Differential rates of risk of psychotic relapse were calculated. Data on some gynecologic variables (postpartum blues, premenstrual tension, psychiatric symptoms triggered perimenstrually, mood symptoms while taking oral contraceptives) were collected. Clinical and psychosocial outcomes were measured by the Global Assessment Scale and Disability Assessment Scale. RESULTS: Patients who presented with major depression and bipolar affective disorder with psychotic features at the initial index episode showed overall diagnostic stability. Many patients with initial brief psychosis (cycloid psychosis) shifted to a clear bipolar affective disorder. The general risk of a psychotic relapse was high (previous psychosis = 0.77 vs first psychotic manifestation = 0.56; not significant). The risk after further pregnancies was 0.57 versus 0.48, respectively (not significant), and the risk regarding at least 1 other psychotic nonindex episode was 0.71 versus 0.44, respectively (P = .015). Gynecologic variables did not significantly discriminate between the groups. In some patients, a possible link to a hormonal susceptibility was discussed. Patients who remained without any further psychotic relapse (n = 24) had a favorable outcome. CONCLUSIONS: Puerperal psychosis of an early onset seemed to be of a prevailing affective nature. Brief psychosis (cycloid psychosis) during a puerperal index episode showed a strong link to bipolar affective disorder in the further course of illness. Outcome was excellent in patients without a further psychotic relapse.
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Objective

To complete a follow-up analysis at a mean of 12 years after patients had presented with an early onset puerperal psychotic index episode.

Method

A retrospective design was used. Patients with puerperal psychosis and onset within 4 weeks after childbirth who had been referred to the Psychiatric Department of the Ludwig Maximilian University of Munich, Munich, Germany, between 1975 and 1995 (maximum: 24 years, minimum: 7 years) were followed up after a mean of 12 years post index episode. Ninety patients were included in the study. Before the index episode, 35 of the patients had previous nonpuerperal psychoses, while 55 patients presented their index episode as the first manifestation of a psychotic illness. Diagnostic evaluation at follow-up was performed by the Structured Clinical Interview for DSM-IV Axis I Disorders according to DSM-IV-TR. Differential rates of risk of psychotic relapse were calculated. Data on some gynecologic variables (postpartum blues, premenstrual tension, psychiatric symptoms triggered perimenstrually, mood symptoms while taking oral contraceptives) were collected. Clinical and psychosocial outcomes were measured by the Global Assessment Scale and Disability Assessment Scale.

Results

Patients who presented with major depression and bipolar affective disorder with psychotic features at the initial index episode showed overall diagnostic stability. Many patients with initial brief psychosis (cycloid psychosis) shifted to a clear bipolar affective disorder. The general risk of a psychotic relapse was high (previous psychosis = 0.77 vs first psychotic manifestation = 0.56; not significant). The risk after further pregnancies was 0.57 versus 0.48, respectively (not significant), and the risk regarding at least 1 other psychotic nonindex episode was 0.71 versus 0.44, respectively (P = .015). Gynecologic variables did not significantly discriminate between the groups. In some patients, a possible link to a hormonal susceptibility was discussed. Patients who remained without any further psychotic relapse (n = 24) had a favorable outcome.

Conclusions

Puerperal psychosis of an early onset seemed to be of a prevailing affective nature. Brief psychosis (cycloid psychosis) during a puerperal index episode showed a strong link to bipolar affective disorder in the further course of illness. Outcome was excellent in patients without a further psychotic relapse. Members Only Content This full article is available exclusively to Professional tier members. Subscribe now to unlock the HTML version and gain unlimited access to our entire library plus all PDFs. If you're already a subscriber, please log in below to continue reading. Buy PDF for $40.00 Please sign in or purchase this PDF for $40.00. Subscribe Now Already a member? Login

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MeSH descriptors

Bipolar Disorder Disease Progression Psychotic Disorders Puerperal Disorders Adult Bipolar Disorder Bipolar Disorder Female Follow-Up Studies Humans Middle Aged Prognosis Psychotic Disorders Psychotic Disorders Puerperal Disorders Puerperal Disorders Recurrence Risk Factors Time Factors Young Adult

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