Abstract
Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.
Highlights
Postpartum psychosis (PP) is a severe mental disorder that typically develops within the first 4 weeks after childbirth[1]
We provide the first evidence that an increased intrinsic functional connectivity of the right dorsolateral prefrontal cortex (DLPFC) within the executive network, correlated with better pre-partum cognitive performance, may represent a marker of resilience to postpartum relapse, as it is present in those women at risk of PP who remain well
We find evidence of an impaired emotional regulation in women at risk of PP, as indicated by their reduced emotional-dependent modulation of functional connectivity of the executive network, which correlated with longer reaction time to the presentation of negative emotional stimuli
Summary
Postpartum psychosis (PP) is a severe mental disorder that typically develops within the first 4 weeks after childbirth[1]. To obtain crucial information on the intrinsic dysfunction of brain networks, and on how their modulation during specific behavioural processes may be impaired in women at risk of PP, it is essential to study both taskdependent and resting functional connectivity simultaneously This can help to establish whether the aberrant interplay of brain networks thought to play a central role in other psychiatric disorders is relevant to vulnerability for PP. Resting-state functional MRI (rs-fMRI) can evaluate the synchrony of blood-oxygen-leveldependent signals of spatially remote brain areas, which is considered to reflect the functional connectivity (FC) of intrinsic brain networks. Using this approach, three largescale brain networks have been consistently identified: the executive, salience, and default mode (DMN) networks. A ‘triple network’ model has been proposed, whereby these networks would interact in controlling higher cognitive and affective functions[10], with the executive network being more active during cognitive and emotional tasks, the DMN showing the opposite activity pattern and the salience network mediating the interplay between the executive network and the DMN
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
