A Matched-control Follow-up and Family Study of ‘Puerperal Psychoses’

Abstract

A hundred and ten women admitted to a psychiatric hospital within 90 days of childbirth were individually matched for age, psychiatric syndrome, and year of admission with women admitted to the same hospital with illnesses unrelated to childbirth. Both groups were followed up after a mean interval of nine years, and 72 matched pairs of patients for whom adequate information was obtained were then compared. The previous and subsequent psychiatric morbidity of these two groups, their subsequent obstetric careers, and the psychiatric morbidity of their first-degree relatives were all very similar. However, the puerperal women had significantly fewer relapses in the follow-up period, fewer committed suicide, and the psychiatric morbidity of their relatives tended to be lower. This better outcome was most marked in puerperal subjects with major depressions; those with manic disorders fared no better than controls. These results suggest that puerperal psychoses are basically the same as affective illnesses occurring at other times but, because childbirth is a uniquely potent precipitant of affective illness, some of those who develop puerperal episodes have a lesser genetic predisposition to affective illness than the generality of women with affective disorders.

Parapartum Mental Illness: A Long-Term Follow-Up Study

“…All patients classified as schizophrenics according to RDC at the index admission were readmitted, while only one third of the women in the group of neuroses and temporary insufficiencies were readmitted. In accordance with earlier studies [6,17,24], the relapse rate related to subsequent childbirth was around 10%. However, some researchers [9, 25] report higher relapse rates (35 and 20.5%, respectively).…”

“…British studies using RDC criteria indicate that approximately 75-80% of the patients hospitalised for postpartum mental illness meet the criteria for affective or schizo-affective disorders [16][17][18]. In our study, only 44% of the patients could possibly be regarded as affective at index admission (schizo-affective disorders and generalised anxiety disorder added).…”

Postpartum psychoses: Prognosis, risk factors, and treatment

“…Several studies [11][12][13] compared course and outcome of the illness in women with a puerperal or a nonpuerperal index episode of an affective illness and found a significantly better prognosis in the women with puerperal index episodes regarding frequency and duration of relapses and social and occupational functioning. In a catamnestic study by the authors' work group [14••], 15% of the patients with puerperal psychoses had a monophasic illness with a single illness episode without further manifestations after a mean length of follow-up of 12.5 years.…”

“…Using the family history method, Platz and Kendell [12] found an insignificantly lower global morbidity risk for psychiatric illness in relatives of women with a puerperal psychosis than in those of nonpuerperal control individuals. Applying the more reliable family study method, Schöpf and Rust [7] also reported an insignificantly lower morbidity risk for functional psychoses in relatives of index patients with puerperal psychoses compared with relatives of psychotically ill women without puerperal onset.…”

Report of the General Psychiatry Section Working Party on Post-Natal Mental Illness

“…Brockington et al (1982), for example, found that perplexity, confusion and be wilderment were particular features of the puerperal psychoses and Dean & Kendell (1981) reported that such women have more florid symptoms, lesser genetic vulnerability, and a slightly better prognosis; although Platz & Kendell (1988) in their prospective studies found that most puerperal psychoses were similar in prognosis to that of manic depressive illness.…”