Adverse Childhood Life Events and Postpartum Psychosis in Bipolar Disorder

Background Women with bipolar disorder are at increased risk of postpartum psychosis. Adverse childhood life events have been associated with depression in the postpartum period, but have been little studied in relation to postpartum psychosis. In this study we investigated whether adverse childhood life events are associated with postpartum psychosis in a large sample of women with bipolar I disorder. Methods Participants were 432 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.BDRN.org). Diagnoses and lifetime psychopathology, including perinatal episodes, were obtained via a semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry; Wing et al., 1990) and case-notes. Adverse childhood life events were assessed via self-report and case-notes, and compared between women with postpartum psychosis (n=208) and those without a lifetime history of perinatal mood episodes (n=224). Results There was no significant difference in the rate of any adverse childhood life event, including childhood sexual abuse, or in the total number of adverse childhood life events between women who experienced postpartum psychosis and those without a lifetime history of perinatal mood episodes, even after controlling for demographic and clinical differences between the groups. Limitations Adverse childhood life events were assessed in adulthood and therefore may be subject to recall errors. Conclusions We found no evidence for an association between adverse childhood life events and the occurrence of postpartum psychosis. Our data suggest that, unlike postpartum depression, childhood adversity does not play a significant role in the triggering of postpartum psychosis in women with bipolar disorder.

History of Premenstrual Mood Change and Postpartum Episodes are Associated with Perimenopausal Episodes in Women with Bipolar Disorder

Background and Aims: Reproductive life events are potential triggers of mood episodes in women with bipolar disorder. We aimed to establish whether a history of premenstrual mood change and postpartum episodes are associated with perimenopausal episodes in women who have bipolar disorder. Methods: Participants were 339 post-menopausal women with DSM-IV bipolar disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). Women self-reported presence (N = 200) or absence (N = 139) of an illness episode during the perimenopausal period. History of premenstrual mood change was measured using the self-report Premenstrual Symptoms Screening Tool (PSST), and history of postpartum episodes was measured via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry, SCAN) and inspection of case-notes. Results: History of a postpartum episode within 6 months of delivery (OR = 2.13, p = 0.03) and history of moderate/severe premenstrual syndrome (OR = 6.33, p < 0.001) were significant predictors of the presence of a perimenopausal episode, even after controlling for demographic factors. When we narrowed the definition of premenstrual mood change to premenstrual dysphoric disorder, it remained significant (OR = 2.68, p = 0.007). Conclusions: Some women who have bipolar disorder may be particularly sensitive to reproductive life events. Previous mood episodes in relation to the female reproductive lifecycle may help clinicians predict individual risk for women with bipolar disorder approaching the menopause. There is a need for prospective longitudinal studies of women with bipolar disorder providing frequent contemporaneous ratings of their mood to overcome the limitations of retrospective self-report data.

Identifying Risk Factors for Postpartum Mood Episodes in Bipolar Disorder – A UK Prospective Study

Background and Aims: Women with bipolar disorder are vulnerable to episodes postpartum, but risk factors are poorly understood. We are exploring risk factors for postpartum mood episodes in women with bipolar disorder using a prospective longitudinal design. Methods: Pregnant women with lifetime DSM-IV bipolar disorder are being recruited into the Bipolar Disorder Research Network (www.BDRN.org). Baseline assessments during late pregnancy include lifetime psychopathology and potential risk factors for perinatal episodes such as medication use, sleep, obstetric factors, and psychosocial factors. Blood samples are taken for genetic analysis. Perinatal psychopathology is assessed via follow-up interview at 12-weeks postpartum. Interview data are supplemented by clinician questionnaires and case-note review. Potential risk factors will be compared between women who experience perinatal episodes and those who remain well. Results: 80 participants have been recruited to date. 32/61 (52%) women had a perinatal recurrence by follow-up. 16 (26%) had onset in pregnancy. 21 (34%) had postpartum onset, 19 (90%) within 6-weeks of delivery: 11 (18%) postpartum psychosis, 5 (8%) postpartum hypomania, 5 (8%) postpartum depression. Postpartum relapse was more frequent in women with bipolar-I than bipolar-II disorder (45% vs 17%). 62% women with postpartum relapse took prophylactic medication peripartum and almost all received care from secondary psychiatric services (95%). Conclusions: Rate of postpartum relapse is high, despite most women receiving specialist care and medication perinatally. A larger sample size will allow us to examine potential risk factors for postpartum episodes, which will assist in providing accurate and personalised advice to women with bipolar disorder who are considering pregnancy.

Postpartum Psychosis in Bipolar Disorder: No Association with Personality, Cognitive Style and Temperament

Background and Aims: Bipolar disorder has been associated with a number of personality traits, cognitive styles and affective temperaments. Women who have bipolar disorder are at increased risk of experiencing postpartum psychosis, however no previous research has investigated these traits in relationship to postpartum episodes. Our aim was to establish whether aspects of personality, cognitive style and affective temperament, that have been associated with bipolar disorder, confer vulnerability to postpartum psychosis over and above their known association with bipolar disorder. Methods: Participants were 552 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). Postpartum psychosis group: lifetime episode of postpartum psychosis within 6 weeks of delivery (N = 284). Non-postpartum psychosis group: no history of any perinatal mood episodes (N = 268). Bipolar disorder-associated personality traits (neuroticism, extraversion, schizotypy and impulsivity), cognitive styles (low self-esteem and dysfunctional attitudes) and affective temperaments were measured using well validated self-report questionnaire measures. Results: After controlling for key demographic, clinical and pregnancy-related variables, and measures of current mood state, there were no statistically significant differences between the postpartum psychosis group and non-postpartum psychosis group on any of the personality, cognitive style or affective temperament measures. Conclusions: Personality traits, cognitive styles and affective temperaments associated with the bipolar disorder diathesis in general were not associated with the onset of postpartum psychosis specifically. We have found no evidence that these traits should play a key role when evaluating risk of postpartum psychosis in women with bipolar I disorder considering pregnancy.

Mania Triggered by Sleep Loss: Implications for Postpartum Psychosis

Background and Aims To examine whether a history of mood episodes triggered by sleep loss is associated with (1) postpartum psychosis (PP) and (2) more broadly-defined postpartum mood episodes that included postnatal depression (PND), in women with bipolar disorder (BD). Methods Participants were 622 parous women with a diagnosis of bipolar-I disorder recruited in the UK to the Bipolar Disorder Research Network. Diagnosis and perinatal episodes were assessed via interview and case note data. Women were also asked during the interview whether episodes of mania and/or depression were triggered by sleep loss. We compared the rates of PP and PND within women who did and did not endorse sleep loss as a trigger of mood episodes. Results Women who reported that their episodes of mania were usually triggered by sleep loss were twice as likely to have experienced an episode of PP (OR = 2.00, 95% CI = 1.20–3.36) than women who did not report this. This effect remained significant when controlling for clinical and demographic factors. We found no significant associations between depression triggered by sleep loss and PP. Analyses in which we defined postpartum episodes at a broader level to include both PP and PND were not significant. Conclusions In pregnant women with BD, a history of mania following sleep loss could be a potential marker of vulnerability to severe postpartum episodes. Further study in prospective samples is required in order to confirm these findings, which may have important implications for understanding the aetiology of PP and of mood disorders more generally.