Postpartum bipolar episodes are not distinct from spontaneous episodes: implications for DSM-V.
BACKGROUND
DSM course modifiers should be based on enough evidence on his impact in the clinical prognosis of patients presenting with a certain clinical feature. The presence of postpartum onset of a mood episode in bipolar disorders has not been sufficiently studied. This is the first prospective clinical study comparing female bipolar patients with and without lifetime history of postpartum mood episode.


METHODS
Systematic prospective follow-up (12 years) of 200 female bipolar I or II patients with or without history of postpartum episodes. Postpartum mood episode was defined according to DSM-IV criteria. Patients with and without postpartum onset of a mood episode were compared regarding clinical and sociodemographic variables.


RESULTS
Lifetime history of postpartum episode was present in 43 patients and absent in 137 patients. Twenty patients were excluded from the study because lack of agreement of the two independent psychiatrist. Both groups showed almost no differences regarding clinical features, functioning or severity.


CONCLUSIONS
The present study does not take account of potential factors that may influence the outcome of a postpartum episode, including obstetric complications and social support before delivery. Similarly, dimensional and qualitative aspects of bipolar disorder were not included in our analysis.


CONCLUSIONS
The role of postpartum onset as a DSM course modifier should be reconsidered, as it seems to have no impact on prognosis or functioning.
Colom
F
F
Bipolar Disorders Program, IDIBAPS, CIBERSAM, University of Barcelona, Spain.
Cruz
N
N
Pacchiarotti
I
I
Mazzarini
L
L
Goikolea
J M
JM
Popova
E
E
Torrent
C
C
Vieta
E
E
D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000209:etiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D012008:Recurrence; D012959:Socioeconomic Factors; D055815:Young Adult