No abstract

No abstract

Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. The risk of PP is very high in women with a history of bipolar affective disorder or schizoaffective disorder. However, the neurobiological basis of PP remains poorly understood and no study has evaluated brain structure in women at risk of, or with, PP. We performed a cross-sectional study of 256 women at risk of PP and 21 healthy controls (HC) in the same postpartum period. Among women at risk, 11 who developed a recent episode of PP (PPE) (n = 2 with lifetime bipolar disorder; n = 9 psychotic disorder not otherwise specified) and 15 at risk women who did not develop an episode of PP (NPPE) (n = 10 with lifetime bipolar disorder; n = 1 with schizoaffective disorder; n = 1 with a history of PP in first-degree family member; n = 3 with previous PP). We obtained T1-weighted MRI scans at 3T and examined regional gray matter volumes with voxel-based morphometry and cortical thickness and surface area with Freesurfer. Women with PPE showed smaller anterior cingulate gyrus, superior temporal gyrus and parahippocampal gyrus compared to NPPE women. These regions also showed decreased surface area. Moreover, the NPPE group showed a larger superior and inferior frontal gyrus volume than the HC. These results should be interpreted with caution, as there were between-group differences in terms of duration of illness and interval between delivery and MRI acquisition. Nevertheless, these are the first findings to suggest that MRI can provide information on brain morphology that characterize those women at risk of PP more likely to develop an episode after childbirth.

Thalamic neurochemical abnormalities may underlie psychotic symptoms and auditory event-related potential (ERP) abnormalities in schizophrenia. We investigated this hypothesis in subjects at risk of psychosis using magnetic resonance spectroscopy and electroencephalography (EEG). Reduced thalamic glutamate plus glutamine and N-acetyl aspartate levels were associated with abnormal frontal ERPs, supporting a thalamic basis for filtering impairments.

−100) with multiple regression analyses using age and sex as covariates. Local connectomes were tracked using a deterministic fiber-tracking algorithm, with seeding density of 100 seeds/ mm 2 , t-threshold of 2.3, and length threshold of 50 mm; all tracks from bootstrap resampling were included. Track trimming was conducted with 5 iterations. A total of 2000 randomized permutations were applied to obtain the null distribution of the track length. Results: Connectometry analysis indicated that greater connectivity in the corpus callosum, external capsule, and cerebellar peduncle at baseline is related to better treatment response after 6 weeks of treatment; no tracks with lower connectivity related to treatment response were found. Conclusion: Our results suggest a relationship between white matter integrity and response to antipsychotic medications. Future studies investigating the pathophysiological mechanisms underlying white matter alterations will be important for targeted drug development and ultimately improvement of outcomes in patients with poor response to conventional antipsychotic medications. Background: Postpartum Psychosis (PP) is a severe psychiatric disorder that usually occurs in the first 4 weeks after giving birth. Although PP occurs in conjunction with the biological changes in childbirth, its neurobiological basis is still poorly understood. Brain vulnerability and inflammation may play a role in the onset of PP, but little research has been done in this area. The aim of this study was to investigate the role of dysmyelination and markers of inflammation in the onset of PP. Methods: Fourteen women at risk of PP and 16 healthy women matched for age, ethnicity, education, and postpartum period were recruited in South London (United Kingdom). Blood samples were collected to measure high sensitivity C-reactive protein (hsCRP), interleukins (IL)-1β, IL-6, IL-10, TNF-a, and vascular endothelial growth factor (VEGF). MRI mcDES-POT sequences were acquired in a GE 3T scanner to measure myelin content. Myelin content and peripheral biomarkers were compared between the 2 groups, and the relationship between myelin content and inflammatory markers was investigated. Results: Women at risk of PP (N = 14) had higher serum level of IL-10 (Mean = 1.57 ng/L, SD = 1.16) and TNF-a (Mean = 2.36 ng/L, SD = 0.89) compared to controls (N = 16, M = 0.87 ng/L, SD = 0.65; M = 1.72 ng/L, SD=0.54, for IL-10 and TNF-a; P < .05), suggestive of a hyperactivation of the immune system in women at risk of PP. There was no significant difference in hs-CRP, IL-6, IL-1b, and VEGF serum levels between women at risk of PP and healthy controls. Women at risk of PP also showed significantly lower myelin content than controls in temporal lobes and sublobar areas (P < .05, corrected). Moreover, no significant association was found between myelin content and markers of inflammation. Conclusion: These findings suggest that peripheral inflammatory markers are raised in postpartum psychosis women. This work represents the first in vivo vi...