On the nosology of severe psychiatric post-partum disorders

Abstract

A group of 57 women, who had been hospitalised for puerperal psychiatric disorders from 1958 to 1977, were reexamined in 1982. The aim of the study was to determine the proportion of patients who had suffered from nonpuerperal psychotic relapses or other subsequent psychopathology, to define the sample diagnostically, taking into account progress in classification, to characterize the so far relatively neglected later course of illness, and to establish criteria related to relapse and global clinical outcome. Of these patients 65% had at least one nonpuerperal relapse, only 25% remained free of later psychopathology, but the global outcome was favorable or relatively favorable in many cases. Of the patients who had had nonpuerperal relapses 43% were classified as suffering from affective psychosis, as many as 38% from schizoaffective psychosis, and only 19% from schizophrenia. Schizoaffective psychosis seems to be particularly liable to be provoked by childbirth. No major evidence was found that endogenous psychoses with puerperal onset and nonpuerperal relapses have a course of illness different from that of the corresponding diagnostic category in general. Cases with exclusively puerperal decompensations seem to be nosologically independent from the traditionally recognized endogenous psychoses. Characteristics strongly related to nonpuerperal relapses were a family history of psychosis and the occurrence of psychotic episodes before the index episode. Puerperal relapses occurred at a much higher rate in patients who also had nonpuerperal relapses than in patients without.

Postpartum Psychoses: Onset and Long-Term Course

“…This study confirms other investigators' findings that psychotic disorders with onset postpartum are recurrent illnesses in the ma jority of cases [2,7,8]. The frequency of relapses during the puerperium found in the present study is about 1 in 4 deliveries, again matching the findings of other authors [2], Considering the total 46 deliveries in the group of 31 women, the ratio becomes even lower, namely about 1:6.…”

“…The majority of psychoses occurred after the first parturition (77.9%) and within 2 weeks after delivery (77.9%), confirming the findings of other au thors [1,7,8]. Nevertheless, in 1 case a post partum psychosis occurred after the birth of the patient's 8 child, presenting with the clini cal picture of a severe organic mental disor der.…”

Long-Term Course and Outcome of Severe Postpartum Psychiatric Disorders

“…In view of the mostly short duration of episodes and the favourable outcome, we agree with Schöpf and Bryois [19] that the fact of having had a puerperal disorder is not in itself sufficient reason for termination of pregnancy. For the same reasons, the advice given to women with a postpartum psychosis to refrain from further pregnancies does not seem justified, despite the high risk of their falling ill again after a subsequent parturition.…”

“…For the same reasons, the advice given to women with a postpartum psychosis to refrain from further pregnancies does not seem justified, despite the high risk of their falling ill again after a subsequent parturition. Other authors [19,21] have drawn identical conclusions concerning this important question. Of course the women and their spouses should be correctly informed about the risk of a relapse as well as the prognosis.…”

“…On the other hand, it would scarcely be feasible to collect a large sample of postpartum psychoses prospectively given their low prevalence. Unlike many other studies of postpartum psychoses, which also include patients not directly contacted [15][16][17][18][19], we interviewed all our patients directly as well as consulting all the available case records, because relying solely on information from other sources might not provide all the data necessary to determine course and outcome with sufficient accuracy. It was thus inevitable that some patients would refuse to participate.…”