title: The relationship between duration of labour, time of delivery, and puerperal psychosis.
abstract: BACKGROUND
  Puerperal psychosis is the most serious psychiatric disorder after childbirth. Despite the ongoing debate regarding its diagnostic status, there is increasing evidence that it is related to bipolar or schizoaffective disorder. Although a well-recognized precipitant of mania, the role of sleep loss has not been systematically studied in the onset of puerperal psychosis. The aim of this study was to test the hypothesis that sleep disruption resulting from longer labour or nighttime delivery would be associated with the onset of puerperal psychosis.
  
  
  METHODS
  Data on duration of labour and time of delivery were compared between a group of patients who were hospitalized with a diagnosis of puerperal psychosis and a group of controls from the same hospitals that were matched on age, parity, and on year of admission to the hospital.
  
  
  RESULTS
  The most common DSM-IV diagnoses were bipolar disorder or schizoaffective disorder. The women in the puerperal psychosis group had a longer duration of labour and were more likely to have a nighttime delivery compared to women in the control group. Insomnia was the most frequent and usually the earliest symptom.
  
  
  CONCLUSIONS
  Small sample size, chart review, no direct measure of sleep, and use of a normal control rather than a comparison group of at-risk women.
  
  
  CONCLUSIONS
  These preliminary findings provide indirect evidence that sleep loss may be a precipitant of puerperal psychosis in women who are biologically predisposed to this illness.
  
  
  BACKGROUND
  This research was supported by the Ontario Mental Health Foundation.
authors.affiliation: Mood Disorders Program, Regional Mental Health Care London, 850 Highbury Ave., PO Box 5532, Station B, Ontario, Canada, N6A 4H1. vsharma@uwo.ca
authors.forename: Verinder
authors.initials: V
authors.lastname: Sharma
authors.forename: Angela
authors.initials: A
authors.lastname: Smith
authors.forename: Mustaq
authors.initials: M
authors.lastname: Khan
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004739:England; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D011247:Pregnancy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D012892:Sleep Deprivation / Q000453:epidemiology* / Q000523:psychology; D013223:Statistics as Topic; D013997:Time Factors