Akademik Veri Yönetim Sistemi
35th ECNP Congress, Vienna, Avusturya, 15 - 18 Ekim 2022, cilt.1,2, ss.357-358
Introduction
Pregnancy and postpartum period are known to be a risk factor for occurrence of a psychiatric disorder or exacerbation of a diagnosed psychiatric disorder, especially affective disorders. Postpartum psychosis (PPP) is a severe psychiatric condition which can present as psychotic depression, mania or non-affective psychosis and it can affect 1 in 500 adult mothers. The pathophysiology of the PPP is not well understood. It is thought that immunological or endocrine changes during pregnancy or postpartum period can affect the occurrence of a PPP episode. As a result of studies comparing symptom profiles of postpartum episodes and non-postpartum episode of affective disorders, it has been hypothesized that PPP can be a presentation of bipolar disorder rather than a distinct clinical phenomenon [1]. Although being in pregnancy or postpartum period leads to some limitations on treatment options, there is no agreed algorithms for the management of psychiatric episodes. In the current study, we aimed to investigate the sociodemographic features, symptom profiles, treatment options, and treatment outcomes of patients having psychiatric episodes during pregnancy or postpartum period with non-postpartum patients.
Method
In this retrospective case-control study, 88 patients in their pregnancy or postpartum period who admitted and had been hospitalized to the Istanbul University Hospital Psychiatry Inpatient Clinic between 2010 and 2020 for any psychiatric disorder was investigated and assessed for their sociodemographic features, symptom profiles, treatments applied during their episodes, follow-up duration and short- and long-term outcomes. These outcomes are compared with the age, disorder and episode matched non-pregnancy or postpartum related hospitalizations as control group in the same years. We compared two groups in terms of sociodemographic and illness related features using independent samples t-test. A p-value less than 0.05 was considered statistical significance.
Results
The mean age of case and control groups were 29.5 and 30.1, respectively. The duration between first diagnosis and hospitalization for the index episode were 71.6 months and 55.8 months.
Regarding clinical features of index episode, statistically significant differences between case and control groups were found for total duration of hospitalization (15 days vs 21 days, p=0.023), duration of untreated period before the index period (77.7 days vs 44.6 days, p=0.008), chlorpromazine equivalent doses of antipsychotics used during the episode (288 mg/day vs 472.7 mg/day, p=0.014), the number of outpatient admissions (75 vs 84, p=0.015).
Presence of depressive/elevated mood, psychotic symptoms, irritability, anxiety and sleep disturbances of case and controls are compared and there were no statistically significant difference.
Conclusion
Overall, patients with pregnancy related psychiatric disorders had fewer days of hospitalization, longer untreated period before the index episode, lower doses of antipsychotics and fewer days of outpatient admissions when compared to controls even though symptom profiles of pregnancy related psychiatric episodes do not differenciate from non-pregnancy related episodes. These differences in the management of the patients during pregnancy or postpartum period might be attributed to the psychiatrists’ attitude toward pregnant/puerperal patients.
References
Bergink V, Rasgon N, Wisner KL. Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. Am J Psychiatry. 2016 Dec 1;173(12):1179-1188. doi: 10.1176/appi.ajp.2016.