From: Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women
Non-postpartum recurrence n = 34 | No recurrence outside the postpartum period n = 72 | p-value | |||
---|---|---|---|---|---|
Baseline characteristics at time of initial episode | |||||
Age in years | Mean = 31.0 | SD = 4.8 | Mean = 31.9 | SD = 4.9 | 0.351 |
Country of origin (n) | |||||
Netherlands | 79.4% | 27 | 94.4% | 68 | 0.018 |
Other | 20.6% | 7 | 5.6% | 4 | |
Marital status (n) | |||||
Married or in relationship | 100.0% | 34 | 91.6% | 66 | 0.217 |
Not in relationship | - | - | 4.2% | 3 | |
Missing | - | - | 4.2% | 3 | |
Education (n) | |||||
No education | 3.0% | 1 | – | – | 0.521 |
Primary school | – | – | 1.4% | 1 | |
Secondary school | 14.7% | 5 | 9.7% | 7 | |
Vocational training | 29.4% | 10 | 30.6% | 22 | |
Higher education | 52.9% | 18 | 58.3% | 42 | |
Parity (n) | |||||
1 | 79.4% | 27 | 79.2% | 57 | 0.343 |
2 | 11.8% | 4 | 16.7% | 12 | |
≥ 3 | 8.8% | 3 | 2.8% | 2 | |
Missing | – | – | 1.4% | 1 | |
Psychiatric history before postpartum episode (n) | |||||
None | 55.9% | 19 | 76.4% | 55 | 0.210 |
Postpartum depression | 8.8% | 3 | 2.8% | 2 | |
Postpartum psychosis/mania (not at other times) | 8.8% | 3 | 5.6% | 4 | |
Depression | 20.6% | 7 | 9.7% | 7 | |
Anxiety | 5.9% | 2 | 2.8% | 2 | |
Hypomania | – | – | 2.8% | 2 | |
Family history of psychiatric disorders† (n) | |||||
None | 47.1% | 16 | 34.7% | 25 | 0.238 |
1st degree relative with depression or anxiety | 41.2% | 14 | 36.1% | 26 | 0.616 |
1st degree relative with postpartum psychiatric episode | 2.9% | 1 | 13.9% | 10 | 0.085 |
1st degree relative with bipolar disorder | 8.8% | 3 | 13.9% | 10 | 0.444 |
Missing | 2.9% | 1 | 4.2% | 3 | 0.745 |
Length of initial hospital admission in days | Mean = 59.6 | SD = 25.6 | Mean = 57.3 | SD = 31.2 | 0.700 |
Phenomenology initial episode (n) | |||||
Manic with and without psychotic features | 58.8% | 20 | 61.1% | 44 | 0.533 |
Psychotic only | 17.7% | 6 | 12.5% | 9 | |
Depressed-psychotic | 5.8% | 2 | 13.9% | 10 | |
Manic-depressed (mixed) | 17.7% | 6 | 12.5% | 9 | |
Relation between mood and psychotic symptoms (n) | |||||
Presence of mood-incongruent psychotic symptoms | 67.6% | 23 | 62.5% | 45 | 0.611 |
> 50% of time psychotic during initial episodes | 52.9% | 18 | 47.2% | 34 | 0.596 |
First rank psychotic symptoms‡ | 8.8% | 3 | 6.9% | 5 | 0.730 |
DSM-IV diagnosis at baseline | |||||
Bipolar I disorder | 82.3% | 28 | 77.8% | 56 | 0.600 |
Bipolar II disorder | 2.9% | 1 | 1.4% | 1 | 0.597 |
Major Depressive Disorder with Psychotic Features | 2.9% | 1 | 11.1% | 8 | 0.159 |
Mood disorders NOS | 8.8% | 3 | 9.7% | 7 | 0.883 |
Lithium treatment during admission (n) | |||||
No | 20.6% | 7 | 25.0% | 18 | 0.617 |
Yes | 79.4% | 27 | 75.0% | 54 | |
Antipsychotics treatment during admission (n) | |||||
No | 14.7% | 5 | 18.1% | 13 | 0.668 |
Yes | 85.3% | 29 | 81.1% | 59 | |
Follow-up | |||||
Length of follow-up period in months | Mean = 46.3 | SD = 20.3 | Mean = 44.5 | SD = 8.8 | 0.543 |
Subsequent pregnancies (n) | |||||
No | 64.7% | 22 | 58.3% | 42 | 0.464 |
Yes | 32.3% | 11 | 40.3% | 29 | |
Missing | 3.0% | 1 | 1.4% | 1 | |
Recurrence period (n) | |||||
Postpartum only | – | – | 3.0 | 2 | < 0.001 |
Non-postpartum only | 90.9% | 30 | - | - | |
Postpartum and non-postpartum | 9.1% | 3 | – | – | |
Recurrence phenomenology (n) | |||||
No recurrence | – | – | 97.2% | 70 | < 0.001 |
Hypo(mania) | 42.4% | 13 | – | ||
Depression/Anxiety | 33.3% | 11 | 2.8*% | 2* | |
Psychotic episode without affective components | 15.2% | 5 | – | – | |
Schizoaffective disorder | 9.1% | 4 | – | – | |
DSM-IV diagnosis at follow-up | |||||
Bipolar I Disorder | 38.2% | 13 | 4.2% | 3 | < 0.001 |
Major Depressive Disorder | 14.7% | 5 | 16.7% | 12 | 0.794 |
Anxiety/Panic Disorder | 11.8% | 4 | 2.8% | 2 | 0.063 |
Brief Psychotic Disorder | 11.8% | 4 | - | - | < 0.001 |
Psychotic Disorder NOS | 2.9% | 1 | - | - | < 0.001 |
Schizoaffective Disorder | 11.8% | 4 | – | – | < 0.001 |
Mood Disorder NOS | 2.9% | 1 | – | – | < 0.001 |
Cyclothymic Disorder | 2.9% | 1 | – | – | < 0.001 |
Observation of other suspected mental condition (V71.09) | 2.9% | 1 | 75% | 54 | < 0.001 |
Lithium stop in follow-up period (n) | |||||
No | 61.8% | 21 | 45.8% | 33 | 0.126 |
Yes | 38.2% | 13 | 54.2% | 39 | |
Recurrence within 6 months after lithium stop (n) | |||||
No | 23.5% | 8 | – | – | < 0.001 |
Yes | 14.7% | 5 | – | – | |
Lithium treatment at follow-up (n) | |||||
No | 38.2% | 13 | 61.1% | 44 | 0.027 |
Yes | 61.8% | 21 | 38.9% | 28 | |
Antipsychotics treatment at follow-up (n) | |||||
No | 76.5% | 26 | 94.4% | 68 | 0.006 |
Yes | 23.5% | 8 | 5.6% | 4 | |
Still in treatment at follow-up (n) | |||||
No | 20.6% | 7 | 68.0% | 49 | < 0.001 |
Yes | 76.5% | 26 | 30.6% | 22 | |
Missing | 2.9% | 1 | 1.4% | 1 |