Abstracts

Abstract

Background: Despite its great clinical importance, there is a paucity of research evidence on bipolar depression after childbirth. It is also common, especially in non-specialist settings, to label all psychiatric disorders occurring in relation to childbirth as postpartum depression and to assume that bipolar and unipolar depression are the same. In this study we aimed to explore (1) whether a history of postpartum depression identified a distinct sub-group of women with bipolar disorder and (2) the clinical features that distinguished between bipolar and unipolar postpartum depression. Methods: One thousand two hundred and ninety five parous women with bipolar disorder and 426 with recurrent major depression were interviewed and case notes reviewed. Best-estimate diagnoses were made according to DSM-IV criteria. A range of clinical variables were investigated using parametric and non-parametric regression approaches. Results: In the bipolar disorder group, women with postpartum depression had a younger age at onset and more deliveries than women without postpartum episodes (p < 0.001). Compared to women with unipolar postpartum depression, those with a bipolar diathesis had more recurrences, younger age at onset and were less likely to have a family history of lifetime or postnatal depression. Combining information on family history, course and age at impairment about 8 out of 10 women with unipolar and bipolar postpartum depression were correctly classified. Conclusions: Our results supported the hypothesis that postpartum depression is an heterogeneous illness.In our analysis postpartum depression did not identify a distinct clinical subtype of bipolar disorder. Women with unipolar postpartum depression had fewer lifetime episodes and were more likely to have a family history of lifetime and postpartum major depression than those with a bipolar diathesis, suggesting a more specific relationship with the childbirth trigger. Background: Cannabis use seems to play a causal role in the development of psychotic disorders. Recent evidence suggests that it may also precipitate onset in bipolar disorder. We here investigate if there is a dose-response relationship between cannabis use and age at onset in bipolar disorder, and whether there are interactions between cannabis use and illness characteristics (presenting polarity and presence of psychosis). Methods: Consecutively recruited patients with a DSM-IV, SCID verified diagnosis of bipolar I, II or NOS disorder (n = 324) participated. Two-way ANCOVAS were used to investigate the effect of levels of cannabis use (<10 times during 1 month lifetime, >10 times during 1 month lifetime or a cannabis use disorder) on age at onset, including interaction effects with illness characteristics, while controlling for possible confounders. RC2 Abstract Withdrawn RC3Results: There was a significant association indicating an inverse dose-response relationship between cannabis use and age at onset, which remained statistically significant after controlling for possible confounder...