Biological stress response in women at risk of postpartum psychosis: The role of life events and inflammation

Aas, Monica; Vecchio, Costanza; Pauls, Astrid; Mehta, Mitul A.; Williams, Steve; Hazelgrove, Katie; Biaggi, Alessandra; Pawlby, Susan; Conroy, Simon; Seneviratne, Gertrude; Mondelli, Valeria; Pariante, Carmine; Dazzan, Paola

doi:10.1016/j.psyneuen.2019.104558

Cited by 26 publications

(46 citation statements)

References 41 publications

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“…The authors propose that this could indicate that increased IL-6 is part of a normal postpartum biological response. In line with this finding, our own research group found no difference in levels of IL-6 between women with PP, those at risk (because of a diagnosis of bipolar disorder, schizoaffective disorder or a history of PP) who were well in the postpartum period and healthy postpartum controls ( Aas et al., 2020 ), supporting the idea that IL-6 does not represent a pathophysiological marker for PP.…”

Section: The Immune System and Ppsupporting

confidence: 60%

“…In addition to IL-8 and hsCRP, previous research has reported increased expression of Monocyte Chemoattractant Protein (MCP)-1 levels in women with first-onset PP, compared with both healthy postpartum and non-postpartum women ( Bergink et al., 2013 ), suggesting that MCP-1 might also be a marker of immune dysregulation in the illness. However, this finding was not replicated in subsequent studies ( Sathyanarayanan et al., 2019 ; Aas et al., 2020 ). Given this inconsistency in findings, the association between MCP-1 and PP requires further investigation.…”

Section: The Immune System and Ppmentioning

confidence: 72%

“…This could be because we measured MCP-1 levels during pregnancy before illness onset, whereas Bergink and colleagues assessed women in the postpartum period during an acute illness state ( Bergink et al., 2013 ). However, as discussed, other studies have not found altered MCP-1 in women with PP ( Sathyanarayanan et al., 2019 ; Aas et al., 2020 ). On the other hand, our findings are in line with the literature on treatment-resistant depression, which found depressed patients who did not respond to pharmacological treatment had lower levels of MCP-1 at baseline than responsive patients ( Carvalho et al., 2013 ).…”

Section: Immune System Dysregulation As a Predictor Of Ppmentioning

confidence: 75%

“…Additionally, our research group found that women with PP had increased high sensitivity (hs) CRP (a more precise measure, which can detect lower levels of CRP) when compared with healthy postpartum women. Interestingly, we found that women at risk of PP who were well in the postpartum period had hsCRP levels that were intermediate between those of women with PP and healthy postpartum women, suggesting that hsCRP might represent a trait marker for severe postpartum mental illness, which is then exacerbated in those women who become unwell after giving birth ( Aas et al., 2020 ). Of note, a recent systematic review and meta-analysis of 21 studies found that elevated CRP was associated with increased risk of suicidality, and particularly suicidal ideation, in individuals with psychiatric disorders, including those with affective and non-affective psychoses ( Miola et al., 2021 ).…”

Section: The Immune System and Ppmentioning

confidence: 99%

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The role of the immune system in postpartum psychosis

Hazelgrove

2021

Brain, Behavior, & Immunity - Health

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Postpartum psychosis is the most severe psychiatric disorder associated with childbirth. The risk is particularly high for women with a history of bipolar disorder or schizoaffective disorder, or those who have suffered a previous episode of postpartum psychosis. However, the aetiology of the illness remains unclear. Pregnancy and the early postpartum are times of significant immunological change. Furthermore, alterations to the immune system have been implicated in the onset and course of various psychopathologies, both related and unrelated to childbirth. Emerging evidence, from studies on immune related disorders, immune cells and inflammatory markers, suggests that the immune system might also be involved in the pathophysiology of postpartum psychosis. Furthermore, recent research has also begun to explore the potential mechanisms underlying immune dysfunction in postpartum psychosis (e.g., disturbances in the Treg–CCN3 protein–(re)myelination axis). Nevertheless, more research is required to understand whether immune dysfunction is a cause or consequence of postpartum psychosis and to clarify the exact mechanisms involved. The aim of this short review is to present the current findings on immune system dysregulation in postpartum psychosis, discuss possible mechanisms underlying the association, highlight potential challenges and confounders and provide suggestions for future research.

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Section: The Immune System and Ppsupporting

confidence: 60%

Section: The Immune System and Ppmentioning

confidence: 72%

Section: Immune System Dysregulation As a Predictor Of Ppmentioning

confidence: 75%

Section: The Immune System and Ppmentioning

confidence: 99%

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The role of the immune system in postpartum psychosis

Hazelgrove

2021

Brain, Behavior, & Immunity - Health

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“…Stressful life events often cause elevated levels of stress and it has been found that patients that had a higher number of stressful life events reported higher perceived stress. [27][28][29] Stress mainly involves the endocrine and nervous systems, both of which are closely linked to the immune system. Dysregulation of the hypothalamicpituitary-adrenal (HPA) axis by chronic stress has been associated with pSS.…”

mentioning

confidence: 99%

Association Between Stressful Life Events and Female Primary Sjogren’s Syndrome and Their Role in Disease Activity: A Retrospective Case–Control Study in China

Meng¹,

Ren²,

Meng³

et al. 2021

NDT

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Purpose: Previous evidence has shown that psychological stress can trigger the onset of autoimmune disease. This study aimed to investigate the prevalence of stressful life events preceding the onset of symptoms in female primary Sjogren's syndrome (pSS) in China compared to controls and the possible associations of stressful life events with disease activity. Patients and Methods: This was a hospital-based retrospective case-control study. Sixtyseven consecutive female pSS patients and an equal number of age-matched (± 3 years) healthy controls were recruited for assessment using the related Stressful Life Events Scale. The pSS disease activity was measured by the EULAR Sjogren's syndrome disease activity index. Data were analyzed by SPSS, version 23, using chi-square, univariate logistic regression, multiple logistic regression, and partial correlation. Results: A higher number of negative stressful life events before disease onset in pSS patients compared with healthy controls suggest that these play a role in increasing the risk of disease occurrence (OR = 2.59, 95% CI: 1.87-3.58, p < 0.05). The number of positive life events did not differ between the two groups. Both the number and severity of the negative stressful life events were also significantly correlated with disease activity. Conclusion: Patients with pSS experienced more negative stressful life events in the year preceding the onset of symptoms than controls. Negative stressful life events before symptom onset may be risk factors for pSS and may affect pSS disease activity.

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