Psychoses complicating childbearing

Abstract

. 1· ;;e:r~~d~~~i~u:£ ~~~r::~o~~ t~~s~~~;:~t :;t;~::i~~b;;:;; i:s4;0e~~ 1 in 1,192. The average of the different ratios cited for Queen Charlotte's Hospital, the Rotunda Hospital in Dublin, Ireland generally, and listed by DeForest, Langdon, Frumkes, Armstrong-Jones, and Partridge is 1 in 858. In other words, of every 858 women who enter the cycle of reproduction, one is likely to become psychotic during the period beginning with conception and ending with lactation. On first thought one might be inclined to dismiss this ratio as being so small as to depict a possibility which need cause little concern. After all, a percentage incidence of slightly more than 0.1 per cent is hardly great enough to merit consideration! We will, nevertheless, pause for a moment of consideration. In the first place these figures represent, for the most part, only those patients 'vho arc sufficiently abnormal mentally to have been noticed by the non= psychiatric observer. In the second place, a good many of the so-called psychotic developments of pregnancy do not manifest themselves until some time after delivery, so that the connection may not be recognized. As a result of these two factors, many of the less spectacular mental states and a number of those which develop postpartum probably do not contribute to the ratio I have given. Consequently, the percentage incidence probably may be assumed to be higher than 0.1 per cent. Let us view the situation from a somewhat different angle. Cole says that 7.5 per cent of all female psychoses are associated with reproduction. DeLee places the figure at 10 to 18 per cent. The State of New York attributes 3 or 4 per cent of its total female state hospital admissions to childbearing. Zilboorg reports that of 10,000 psychotic women, the psyehoses were incidental to pregnancy and its sequelae in 8.7 per cent. Stone and Karnosh found a similar association in 5.5 per cent of 1,604 psychotic women. If we roughly average these percentages, we obtain a result of 8.9 per cent. It may be said, then, that of all females who suffer from psychoses of various sorts, almost 9 per cent develop their mental disorders in connection with the reproductive experience. That 9 per cent, it seems to me, places a problem squarely in the laps of obstetricians. Since an appreciable proportion of the psychotic female population develops its mental disturbances while under the observation of the