The picture puzzle of the postpartum psychoses
Abstract
A search was made for prenatal and perinatal factors associated with psychoses developing in women within 6 months after childbirth. A total of 126 patients whose first mental derangement was a postpartum psychosis were identified from Cincinnati, Ohio, hospital service area records of 1950 through 1958. No differences among clinical types were found related to the factors studied. Onset in 85 per cent of patients occurred during the puerperium in direct temporal relation to genital involution.
The incidence rate of first attacks in 1957 through 1958 was 0.7 per 1,000 live births. When recurrences in women with prior postpartum episodes or reactivated psychoses unassociated with previous pregnancies were included, attack rates were 1.1 per 1,000 live births. Rates increased with age and were higher among Negroes than among whites.
Pertinent somatic information for each psychotic patient was compiled from hospital obstetric records documented before overt mental aberrations had developed. For control purposes similar data were obtained for the immediately preceding and following mothers of the same race delivered in the same obstetric unit.
Psychotic patients were found to be older than control subjects at each parity; however, multiparous women were of comparable age at their first pregnancy.
In mean parity the white patients and controls were similar. Negro patients had produced fewer viable children (and more patients were primiparas) than their controls. Proportionately more psychotic patients than control subjects among multiparas of each race showed intervals of 5 or more years between their most recent and their immediately preceding pregnancies.
Psychotic patients had shorter gestational periods than control subjects. Infants born alive to patients weighed less than those to controls.
Larger proportions of psychotic patients than control subjects complained of headache and manifested hypertension during pregnancy or parturition. Also, larger proportions of psychotic patients complained of respiratory illness and experienced dystocia. Presumably as a consequence of less favorable gestational environment, the perinatal mortality rate was higher among infants of psychotic patients.
No proportional differences existed between patients and controls as to age at marriage or legitimacy of infants.
Twenty-one patients experienced 26 recurrent episodes of psychosis in 74 subsequent pregnancies that reached 20 or more weeks of gestation, a recurrence rate of 35 per 100 such pregnancies.
The results cited are positive findings of somatic differences. It is speculated that postpartum psychoses are primarily of somatic rather than psychic origin.
References (1)
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Psychosis After Childbirth: Ecological Aspects of a Single Impact Stress
Am. J. M. Sc.
(1959)
Cited by (59)
Premature delivery: A traumatic birth? Posttraumatic stress symptoms and associated features
2014, Gynecologie Obstetrique et FertiliteBien que les études sur le thème de l’état de stress posttraumatique (ESPT) en lien avec l’expérience de l’accouchement tendent à se développer, il n’existe, à notre connaissance, que peu de recherches réalisées en population française. Le but de l’étude est de relever la prévalence de femmes qui développent un probable ESPT suite à leur expérience de l’accouchement avant-terme et de dégager les variables associées à ce trouble.
Dans les 4 semaines suivant le retour à maison de l’enfant prématuré, 110 femmes françaises (âge moyen [ET] = 29,5 [4,3] ans) ayant accouché avant-terme ont complété une série de questionnaires mesurant les symptômes de stress posttraumatique (Impact of Event Scale-Revised) et de dépression postnatale (Edinburgh Postnatal Depression Scale), la qualité de la relation conjugale (Dyadic Adjustment Scale) et le soutien en provenance du conjoint (Multidimensional Scale of Perceived Social Support). Les données sociodémographiques et gynécologiques ont également été récoltées.
Trente pour cent des femmes de l’échantillon ont rapporté un score à l’Impact of Event Scale-Revised indiquant un probable état de stress posttraumatique. La présence de symptômes de dépression postnatale élevés (β = 0,47, p < 0,05), l’accouchement par césarienne (β = 0,24, p < 0,05) et la présence d’un événement traumatique dans les 24 mois précédant l’accouchement (β = 0,20, p < 0,05) étaient indépendamment associés à l’intensité des symptômes de stress posttraumatique.
Compte tenu de l’impact traumatique de cette naissance sur la mère, il semble judicieux de poursuivre les recherches sur le traumatisme de l’accouchement avant-terme.
While researches focusing on posttraumatic stress disorder (PTSD) symptoms following childbirth tend to develop, few studies have been conducted on French samples. The aim of the current study was to explore the prevalence rate of women developing postpartum PTSD following preterm birth and highlighting associated features.
In the 4 weeks following the preterm infant's hospital discharge, a sample of 110 French women (mean age [SD] = 29.5 [4.3] years) who delivered prematurely completed questionnaires assessing PTSD symptoms (Impact of Event Scale-Revised) postpartum depressive symptomatology (Edinburgh Postnatal Depression Scale), quality of marital relationship (Dyadic Adjustment Scale) and partner support (Multidimensional Scale of Perceived Social Support). Sociodemographic and gynecologic data were also gathered.
Thirty percent of our sample reported a score on the IES-R highlighting a probable posttraumatic stress disorder. Increased postpartum depressive symptoms (β = 0.47, P < 0.05), having undergone a caesarian section (β = 0.24, P < 0.05), and prior traumatic event (β = 0.20, P < 0.05), were independently associated with the intensity of PTSD symptoms.
Given the traumatic impact of preterm birth on mothers, further studies focusing on the trauma of premature delivery are warranted.
Structure of depressive symptoms in pregnancy and the postpartum period
1999, Journal of Affective DisordersBackground: The present study investigated the structure of depressive symptoms in the perinatal period. Method: The Zung Self-Rating Depression Scale (SDS) was administered to a total of 1329 women in early, middle and late pregnancy and 5 days, 1 month, 6 months, 12 months and 18 months after the delivery. Results: A number of somatic items and the suicidal ideation item of the SDS made low contributions to the evaluation of the severity of depression, and as a consequence these were excluded in the principal component analysis. Three factors were interpretable as “Cognitive”, “Affective insomnia” and “Attentional” emerged at all eight assessment points. The goodness-of-fit index (GFI) generated by confirmatory factor analyses (LISREL 7.20) proved sufficiently high on all eight occasions. Limitation: The present study investigated only one self-rating scale and the sample comprised Japanese mothers only. Conclusion: The three-factor model of the SDS in the perinatal period was derived from exploratory and confirmatory factor analyses. It is noteworthy that the same three-factor structure emerged at all eight collection points in the present study.
Adverse pregnancy outcome in schizophrenic women: Occurrence and risk factors
1998, Schizophrenia ResearchLow birth weight and preterm birth are important predictors of infant mortality and morbidity, and may increase the risk of schizophrenia. These adverse outcomes of pregnancy could be associated, therefore, with increased risk in children genetically predisposed to schizophrenia. The aim of this review was to describe the occurrence of risk factors for low birth weight, preterm birth, and perinatal death among schizophrenic women, and to describe the incidence of those adverse pregnancy outcomes among schizophrenic women. Smoking, substance abuse, and low socioeconomic status are associated with fetal growth retardation, preterm birth, and perinatal death, and also with schizophrenia. Therefore, increased incidence of adverse pregnancy outcome should be expected in schizophrenic women. The available evidence suggests that schizophrenic women are at increased risk of delivering infants with low birth weight, but the existing studies are of small statistical power. Preterm birth and perinatal death have only been investigated little among schizophrenic women. An important focus of future research should be to establish the risk of adverse pregnancy outcome, and to study the association between the suspected risk factors and pregnancy outcome in schizophrenic women. In clinical work with pregnant schizophrenic women, efforts should be made to prevent exposure to suspected risk factors like smoking, substance use, and socioeconomic problems. This could possibly decrease the mortality and morbidity, including the risk of schizophrenia in the offspring, and clarify the importance of environmental and genetic factors in the etiology of schizophrenia.
Stress and Human Reproductive Behavior: Attractiveness, Women's Sexual Development, Postpartum Depression, and Baby's Cry
1998, Advances in the Study of BehaviorSystematic review of the association between adverse life events and the onset and relapse of postpartum psychosis
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