Puerperal Psychosis: Phenomena and Diagnosis
01 Jul 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 7, pp 829-833
TL;DR: The results are interpreted as supporting a link between puerperal psychosis and manic-depressive disease.
Abstract: Fifty-eight psychoses beginning within two weeks of childbirth are compared with 52 episodes of nonpuerperal psychotic illness occurring in young women. A clinical approach based on the use of multiple information sources and integrated assessment was used. Statistically significant differences between the two groups of patients were found in 52 of 214 psychopathological variables. Postpartum patients had more manic symptoms and "confusion," while nonpuerperal patients had more schizophrenic symptoms. The Research Diagnostic Criteria (RDC) showed an excess of schizoaffective (manic) puerperal patients and schizoaffective (depressed) or schizophrenic nonpuerperal patients. Only five of 58 puerperal episodes met RDC for schizophrenia. The relative lack of schizophrenic symptoms in the puerperal group was confirmed by self-ratings. The results are interpreted as supporting a link between puerperal psychosis and manic-depressive disease.
Citations
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TL;DR: Critical appraisal of the literature revealed a number of methodological and knowledge gaps that need to be addressed in future research, including examining specific risk factors in women of lower socioeconomic status, risk factors pertaining to teenage mothers, and the use of appropriate instruments assessing postpartum depression for use within different cultural groups.
1,502Â citations
Cites background from "Puerperal Psychosis: Phenomena and ..."
...The presenting symptoms are typically depressed or elated mood (which can fluctuate rapidly), disorganized behavior, mood lability, and delusions and hallucinations [12]....
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TL;DR: Clinical aspects of sex differences in affective disorders including the emergence ofsex differences across developmental stages and the impact of reproductive events are focused on.
834Â citations
Cites background from "Puerperal Psychosis: Phenomena and ..."
...Women with postpartum manic episodes often experience more disorganization, disturbed sensorium, bizarre behavior, and sense of persecution than seen in typical manic episodes (Brockington et al., 1981; Wisner et al., 1994)....
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Journal Article•
TL;DR: The evaluation of postpartum mood disturbance is discussed and guidelines for the treatment of affective illness during the puerperium are offered.
Abstract: Mood disturbance occurs commonly during the postpartum period. The symptoms may be transient and relatively mild (as in postpartum blues) or may be associated with significant impairment of functioning (as in postpartum depression and puerperal psychosis). Despite the prevalence of postpartum mood disorders, depressive symptoms that emerge during the puerperium are often overlooked. Puerperal affective illness places the mother at risk for the development of recurrent depression and has also been associated with significant long-term effects on child development and behavior. Therefore, the prompt recognition and efficacious treatment of puerperal mood disorders are essential in order to avoid adverse outcomes for both mother and infant. This article discusses the evaluation of postpartum mood disturbance and offers guidelines for the treatment of affective illness during the puerperium.
602Â citations
Cites background from "Puerperal Psychosis: Phenomena and ..."
...In general, puerperal psychosis evolves rapidly and is characterized by depressed or elated mood, disorganized behavior, mood lability, and delusions and hallucinations.(33) There has been considerable debate as to whether postpartum psychosis is a discrete diagnostic entity or whether it represents a rapidly evolving affective psychosis....
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...Some have suggested that puerperal psychosis may be clinically distinct in that it is more commonly associated with delirium and confusion than nonpuerperal affective psychosis.(32,33,36) While fulminant postpartum depression and psychosis are easily detected, less severe presentations of depressive illness are frequently missed....
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TL;DR: Perinatal mental illness is a significant complication of pregnancy and the postpartum period and early detection and effective management of perinatal psychiatric disorders are critical for the welfare of women and their offspring.
Abstract: Perinatal mental illness is a significant complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder. Perinatal depression and anxiety are common, with prevalence rates for major and minor depression up to almost 20% during pregnancy and the first 3 months postpartum. Postpartum blues are a common but lesser manifestation of postpartum affective disturbance. Perinatal psychiatric disorders impair a woman's function and are associated with suboptimal development of her offspring. Risk factors include past history of depression, anxiety, or bipolar disorder, as well psychosocial factors, such as ongoing conflict with the partner, poor social support, and ongoing stressful life events. Early symptoms of depression, anxiety, and mania can be detected through screening in pregnancy and the postpartum period. Early detection and effective management of perinatal psychiatric disorders are critical for the welfare of women and their offspring.
601Â citations
TL;DR: In summary, MDD is a highly prevalent major medical whose pathophysiology is still poorly understood and evidence suggests that genetic factors partially influence overall risk of illness but also influence the sensitivity of individuals to the depressogenic effects of environmental adversity.
454Â citations
References
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TL;DR: The Kw provides for the incorpation of ratio-scaled degrees of disagreement (or agreement) to each of the cells of the k * k table of joi.
Abstract: A previously described coefficient of agreement for nominal scales, kappa, treats all disagreements equally. A generalization to weighted kappa (Kw) is presented. The Kw provides for the incorpation of ratio-scaled degrees of disagreement (or agreement) to each of the cells of the k * k table of joi
7,604Â citations
Book•
01 Jan 1976
TL;DR: A facsimile reprinting of Kraepelin's great German textbook, "Manic-Depressive Insanity and Paranoia" (1921), which showed for the first time that psychotic depression could have alternating forms of mania and severe melancholy.
Abstract: The German psychiatrist Emil Kraepelin (1856-1926) is justly called "the father of modern psychiatry". He was the first to identify schizophrenia and manic-depression, and he pioneered the use of drugs to treat mental illness. He was also joint discoverer of Alzheimer's disease - which he named after his collaborator, Dr Alois Alzheimer. Kraepelin presented these and other discoveries in successive editions of his "Psychiatrie: Ein Lehrbuch" (definitive 8th edition also now available from Thoemmes Press). Much of this gigantic textbook can only be read in the original German; but parts of it were translated into English, and they had a very profound influence on the development of world psychiatry for the rest of the 20th century. "Manic-Depressive Insanity and Paranoia" (1921) was the last section of Kraepelin's great German textbook to be translated into English. Published in 1921, the book showed for the first time that psychotic depression could have alternating forms of mania and severe melancholy. In Kraepelin's view both manic-depression and dementia praecox (or "schizophrenia") were endogenous psychoses, originating in biological disorder; but he distinguished dementia praecox as deteriorating - that is, as having a very poor prognosis for recovery - from his new category of manic-depression, which was non-deteriorating. Kraepelin's classifications of these disorders have persisted into the 21st century, yet the books in which he first explained them to the English-speaking world have become very hard to find. This facsimile reprinting of "Manic-Depressive Insanity and Paranoia" should be of interest to researchers in academic and clinical psychiatry, and to those with a more general interest in the history of medicine.
1,665Â citations
TL;DR: The article by Overall and Hollister in this paper "Comparative Evaluation of Research Diagnostic Criteria for Schizophrenia" troubles us for several reasons, such as the authors do not address the issue of the different purposes of various sets of research diagnostic criteria.
Abstract: To the Editor— Although we welcome discussion of the relative merits of different research criteria for Psy chiatric diagnosis, the article by Drs Overall and Hollister in theArchives(36:1198-1205, 1979) "Comparative Evaluation of Research Diagnostic Criteria for Schizophrenia" troubles us for several reasons. First of all, the authors do not address the issue of the different purposes of various sets of research diagnostic criteria. Whereas the purpose of the actuarial approach taken by Drs Overall and Hollister is to simulate competent or expert clinical practice, the purpose of the Washington University criteria, research diagnostic criteria (RDC), and DSMIII criteria is to improve usual clinical practice by incorporating into the criteria distinctions that have been shown by research study to have some validity in terms of such variables as course, response to specific therapy, familial pattern, etc. Given this difference in purpose, it is hardly adequate to approach the evaluation
1,429Â citations
Journal Article•
TL;DR: The purpose of the Washington University criteria, research diagnostic criteria (RDC), and DSMIII criteria is to improve usual clinical practice by incorporating into the criteria distinctions that have been shown by research study to have some validity in terms of such variables as course.
Abstract: To the Editor— Although we welcome discussion of the relative merits of different research criteria for Psy chiatric diagnosis, the article by Drs Overall and Hollister in theArchives(36:1198-1205, 1979) \"Comparative Evaluation of Research Diagnostic Criteria for Schizophrenia\" troubles us for several reasons. First of all, the authors do not address the issue of the different purposes of various sets of research diagnostic criteria. Whereas the purpose of the actuarial approach taken by Drs Overall and Hollister is to simulate competent or expert clinical practice, the purpose of the Washington University criteria, research diagnostic criteria (RDC), and DSMIII criteria is to improve usual clinical practice by incorporating into the criteria distinctions that have been shown by research study to have some validity in terms of such variables as course, response to specific therapy, familial pattern, etc. Given this difference in purpose, it is hardly adequate to approach the evaluation
522Â citations
TL;DR: Behavioral data on a large patient group collected by investigators from nine countries in the International Pilot Study of Schizophrenia resulted in an operational method for identifying patients who would be commonly considered schizophrenic in many centers.
Abstract: Behavioral data on a large patient group were collected by investigators from nine countries in the International Pilot Study of Schizophrenia, sponsored by the World Health Organization. The data on half the group were analyzed to derive a system of 12 signs and symptoms for the identification of schizophrenia, as this disorder is diagnosed in many centers throughout the world. The findings were replicated with the other half of the patient group. The criteria constitute an operational method for identifying patients who would be commonly considered schizophrenic in many centers.
419Â citations