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Women with Postpartum Psychosis or Bipolar Disorder: Look to the Past?

Most women hospitalized for postpartum psychosis have histories of psychiatric hospitalization.

Across cultures, postpartum psychosis is estimated to occur in 1–2/1000 postpartum women. These investigators used Swedish registry data to examine whether postpartum psychosis occurs de novo or is associated with a history of psychiatric hospitalization. The study population was 612,306 women who gave birth to a live first child between 1987 and 2001.

The incidence of hospitalization for psychosis or bipolar disorder within 90 days of childbirth was 0.10% (0.07% for psychosis, 0.03% for bipolar disorder). Incidence of postpartum hospitalization was 0.04% for psychosis and 0.01% for bipolar disorder in women with no previous psychiatric hospitalizations and 9.24% and 4.48% in women with such hospitalizations. More than 40% of women hospitalized during pregnancy were rehospitalized during the postpartum period. About 90% of postpartum psychotic or bipolar episodes occurred within the first 4 weeks postpartum. The risk for hospitalization increased with the recency and number of prior hospitalizations.

Comment: This population-based study of a very large sample adds valuable data regarding postpartum psychosis and bipolar disorder. Limitations include the use of hospitalization to estimate incidence of episodes, the lack of data regarding whether bipolar episodes were depressive or manic or included psychotic symptoms, and the lack of confirmatory diagnostic interviews. Nonetheless, the incidence of postpartum psychotic or bipolar episodes is consistent with prior data, and the study shows that most cases of postpartum psychosis or bipolar disorder occur in women with psychiatric histories. The findings emphasize the importance of identifying such women early in pregnancy and of collaboration between their obstetricians and psychiatrists.

— Deborah Cowley, MD

Published in Journal Watch Psychiatry February 26, 2007

Citation(s):

Harlow BL et al. Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations. Arch Gen Psychiatry 2007 Jan; 64:42-8.

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