'Isolated postpartum psychosis' a necessary diagnostic category, researchers suggest

Researchers classified more than 40% of women with postpartum psychosis as having “isolated” cases, according to results of a systematic review and meta-analysis published in Journal of Clinical Psychiatry.

Isolated postpartum psychosis could be considered a distinct diagnostic category with a more favorable prognosis, they posited.

“With an adequate treatment regimen, nearly all women with [postpartum psychosis] achieve full remission, and the majority of patients achieve good functional recovery,” Janneke Gilden, MD, of the department of psychiatry at Erasmus Medical Center Rotterdam in the Netherlands, and colleagues wrote. “However, after remission, women with a first-onset [postpartum psychosis] are known to be at high risk [for] subsequent postpartum and nonpostpartum psychiatric episodes. For some women, first-onset [postpartum psychosis] is the incipient episode of a lifelong affective disorder, mainly within the bipolar spectrum.”

However, other women are at risk for subsequent severe psychiatric episodes only during the postpartum period, a pattern known as isolated postpartum psychosis. Currently, the magnitude of this risk is unknown, with limited information on the longitudinal disease course after first-onset postpartum psychosis. Further, information is sparse regarding prognostic markers for the disease course.

Gilden and colleagues sought to estimate the risk of recurrence after first-onset postpartum psychosis. They conducted a literature search using seven databases, combined key terms regarding longitudinal studies of first-onset postpartum psychosis from inception through May 9, 2019, and used two levels of screening on 2,807 citations. In the quantitative analysis, they included six English-language articles with data of 645 patients with a first-onset postpartum psychosis within 1 year following childbirth and a minimum follow-up period of 18 months or more after the index episode. Recurrence, defined as any subsequent psychiatric episode after first-onset postpartum psychosis, served as the primary outcome. Follow-up periods were 11 years to 26 years.

Results showed 279 patients did not experience subsequent severe episodes outside the postpartum period. The researchers reported a weighted estimate of 43.5% (95% CI, 37.7-49.4) based on meta-analysis using random-effect estimation.

“We found a high suicide risk, particularly after hospital discharge,” the researchers wrote. “This finding is alarming, given that [postpartum psychosis] is a condition with a generally optimistic prognosis following remission of the initial acute episode.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.