title: Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis.
abstract: OBJECTIVE
  Women who experience postpartum psychosis (PP) seek guidance on further pregnancies and risk of illness; however, empirical data are limited. This study describes reproductive and mental health outcomes in women diagnosed with PP and examines clinical risk factors as predictors of further illness.
  
  
  METHODS
  A retrospective cohort design was used; 116 women who experienced episodes of mania or depression with psychotic features within six weeks of childbirth were recruited. All subjects underwent clinical diagnostic interviews and medical case notes were reviewed.
  
  
  RESULTS
  Only 33% of women had an antecedent history, of which 34% had bipolar disorder and 55% unipolar depression. Only 58% of those with PP in their first pregnancy had a subsequent pregnancy, and 18% of marriages ended following the PP episode. Clinical presentation at the time of initial episode did not influence the timing of the onset of symptoms, treatment, or recovery. Although 86% of patients received treatment within 30 days of onset, 26% of women reported ongoing symptoms at a year after delivery. The recurrence rate of PP was 54.4%; a longer duration of the index episode (p < 0.05) and longer latency between the index PP and next pregnancy predicted a subsequent PP. The rate of subsequent non-puerperal episodes was 69%, and all these episodes were bipolar.
  
  
  CONCLUSIONS
  Postpartum psychosis is difficult to predict in women with no antecedent history and is associated with a high rate of subsequent puerperal and non-puerperal illness. Risk of further illness needs to be conveyed in order to allow fully informed decisions to be made regarding future pregnancies.
authors: Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY.
authors: Emma Robertson
authors: ER
authors: Blackmore
authors: David R
authors: DR
authors: Rubinow
authors: Thomas G
authors: TG
authors: O'Connor
authors: Xiang
authors: X
authors: Liu
authors: Wan
authors: W
authors: Tang
authors: Nick
authors: N
authors: Craddock
authors: Ian
authors: I
authors: Jones
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis; D003863:Depression / Q000175:diagnosis; D019468:Disease Management; D005260:Female; D006801:Humans; D008603:Mental Health; D011247:Pregnancy; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D012008:Recurrence; D060728:Reproductive Health; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D016387:Women's Health
keywords: perinatal psychiatry; postpartum psychosis; pregnancy; recurrence
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