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Obstetric variables associated with bipolar affective puerperal psychosis

Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham, UK, and Department of Psychiatry, University of Rochester Medical Center, New York, USA

IAN JONES, PhD, MRCPsych

Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham, and Neuropsychiatric Genetics Unit, Department of Psychological Medicine, University of Cardiff

MONICA DOSHI, MRCPsych

Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham, and St Michael's Hospital, Warwick

SAYEED HAQUE, PhD

Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham

ROGER HOLDER, BSc

Department of Primary Care and General Practice, University of Birmingham

IAN BROCKINGTON, PhD, FRCPsych

Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham

NICK CRADDOCK, PhD, MRCPsych

Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham, and Neuropsychiatric Genetics Unit, Department of Psychological Medicine, University of Cardiff, UK

Correspondence: Dr Ian Jones, Neuropsychiatric Genetics Unit, Department of Psychological Medicine, University of Cardiff, Heath Park, Cardiff CF14 4XN, UK. Tel: +44 (029) 2074 4663; fax: +44 (029) 2074 6554; e-mail: jonesir1{at}cf.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Previous cross-sectional studies have highlighted a number of obstetric variables that may be associated with the development of broadly defined puerperal (post-partum) psychosis. These include: (a) primiparity, (b) pregnancy complications, (c) delivery complications, (d) Caesarean section, (e) female baby and (f) shorter gestation period.

Aims To examine these risk factors in women with well-characterised bipolar affective puerperal psychosis.

Method A sample of 129 women with bipolar affective puerperal psychosis were investigated using a design that takes advantage of within-subject comparisons of affected and unaffected deliveries.

Results Two of the variables studied were independently associated with an episode of puerperal psychosis: primiparity (odds ratio=3.76, P < 0.001) and delivery complications (odds ratio=2.68, P=0.022).

Conclusions This study provides further evidence of the association between primiparity and puerperal psychosis and suggests that complications during delivery may be associated with a severe post-partum episode.

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