Psychoses in puerperium: symptoms, course and long-term prognosis

Abstract

86 women who suffered from a psychotic disorder for the first time in their life within 6 weeks after parturition, were investigated regarding sociodemographic and gynaecological parameters, time of onset and initial symptomatology, psychopathological symptoms during hospitalisation, treatment and short-term outcome of the illness. The majority of patients became ill after the first (75%), full-term normal (63%) delivery and within the first two postpartum weeks (78%). The most frequent initial symptoms were anxiety, restlessness, depressive mood, sleep disturbances, behaviour disturbances, catatonic excitement, delusions and hallucinations. By the time of follow-up investigation, 16 women had died; 61 women were investigated on average 25.6 years after onset (minimum 12, maximum 41 years), using standardised instruments of evaluation. Nearly two-thirds of the patients had suffered re-manifestation of psychotic disorder during a long-term course (64%). The frequency of re-manifestations of illness after additional pregnancies and deliveries was found to be 1:4, which is also known to be the expected frequency during the course of other psychotic disorders. These results do not justify the global recommendation to avoid additional pregnancies or carry out an interruption of pregnancy, if the patient has a history of postpartum psychosis. The climacteric period also seems to be a vulnerable phase for the re-manifestation of illness. Nearly 3/4 of the investigated women displayed no disturbances in any of the evaluated dimensions (psychopathological, psychological, psychosocial status) at the time of follow-up.