Perinatal psychosis in mothers with a history of major depressive disorder

Abstract

Purpose-While women with a history of major depressive disorder (MDD) have higher chances for postpartum depressive and manic episodes, little is known about their chance for postpartum psychosis (PPP). We prospectively assessed the frequency of perinatal psychotic symptoms among primiparous women with a history of MDD only (structured clinical interview was used to exclude women with pre-existing histories of mania or psychosis), and explored whether sex of the baby influenced these symptoms.Methods-The presence of symptoms of psychosis was defined using previously established cutoff scores on five key items from the Positive and Negative Syndrome Scale (PANSS), which was administered during pregnancy, at 1 week, 1 month, and 3 months postpartum.Results-Fourteen of 60 women (23%) scored above threshold for psychosis at one or more time-points, with six experiencing postpartum onset. There was a non-significant trend (p = 0.073) towards higher frequency of these symptoms among mothers of girls.Conclusions-If controlled studies using diagnostic interviews confirm that psychotic symptoms are relatively common among women with MDD, monitoring for psychosis during the perinatal period may be indicated in this population. The potential effect of sex of the baby on mothers' chance for PPP requires further study.

The psychometric properties of the 16-item version of the Prodromal Questionnaire (PQ-16) as a screening instrument for perinatal psychosis

“…For women with histories of bipolar disorder or previous episodes of PP, the risk of PP is 30% (Jones & Craddock, 2001; Robling, Paykel, Dunn, Abbott, & Katona, 2000; Sit et al, 2006). Women with histories of major depression also face an elevated risk of PP, on the order of 2–23% (Di Florio et al, 2012; Mighton et al, 2016). In nearly half of cases, PP represents the first psychotic episode for the patient (Valdimarsdottir, Hultman, Harlow, Cnattingius, & Sparen, 2009).…”

Identifying Prodromal Symptomology in Women Who Experienced Postpartum Psychosis: A Grounded Research Study

“…25 Paranoia and suspiciousness are known symptoms in women diagnosed with PPP. 27,28 In our study, it was noted as a prodromal symptom that occurred before the actual diagnosis and the emergence of hallucinations or delusions. Women often have paranoid thoughts about others opinions of how they are caring for their infant.…”

Prenatal genetic counselling for psychiatric disorders

“…Guidelines suggest that all healthcare professionals who come into contact with pregnant women should screen their patients for mental health problems, but this becomes particularly important in the context of prenatal PGC when the patient has a personal history of psychiatric illness, as they are at increased risk for relapse in the perinatal period . Perinatal psychiatric illness can have profound consequences: suicide is the leading cause of maternal death during the first year postpartum, and women with a history of mood or psychotic disorders have an increased chance to develop postpartum psychosis, which is considered a psychiatric emergency …”

“…[37][38][39][40]54 Perinatal psychiatric illness can have profound consequences: suicide is the leading cause of maternal death during the first year postpartum, and women with a history of mood or psychotic disorders have an increased chance to develop postpartum psychosis, which is considered a psychiatric emergency. 39,40,[55][56][57] Screening for current mental health issues can be accomplished through simple questioning about whether they are currently noticing any of the symptoms that they have experienced in the past, but ideally involves using a validated tool like the Edinburgh Postpartum Depression Scale. 53 This 10-item scale has been validated for use in both pregnancy and the postpartum, is available in several languages and takes about 5 min to complete, [58][59][60] and so can easily be incorporated into the beginning of a prenatal PGC appointment.…”