Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women

Anna Sophie Rommel, Nina Maren Molenaar, Janneke Gilden, Steven A. Kushner, Nicola J. Westerbeek, Astrid M. Kamperman, Veerle Bergink

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Objective: We aimed to investigate the outcome of postpartum psychosis over a four-year follow-up, and to identify potential clinical markers of mood/psychotic episodes outside of the postpartum period. Methods: One hundred and six women with a diagnosis of first-onset mania or psychosis during the postpartum period were included in this prospective longitudinal study. Women were categorized into either (1) recurrence of non-postpartum mood/psychotic episodes or (2) mania/psychosis limited to the postpartum period. We summarize the longitudinal course of the illness per group. We used a logistic regression model to identify clinical predictors of recurrence of mood/psychotic episodes outside of the postpartum period. Results: Over two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%. Of these women, most transitioned to a bipolar disorder diagnosis. None of the women fulfilled diagnostic criteria for schizophrenia or schizophreniform disorder. No clinical markers significantly predicted recurrence outside of the postpartum period. Conclusions: For the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors for risk of severe episodes outside the postpartum period emerged. Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.

Original languageEnglish
Article number31
JournalInternational Journal of Bipolar Disorders
Volume9
Issue number1
DOIs
StatePublished - Dec 2021

Keywords

  • Bipolar disorder
  • Clinical predictors
  • Course of illness
  • Longitudinal follow-up
  • Postpartum psychosis

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