Recurrent Post-Partum Psychosis

Kumar, R.; Isaacs, Stephen; Meltzer, E. S.

doi:10.1192/bjp.142.6.618

Cited by 14 publications

(1 citation statement)

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“…Prospective investigations of such women through pregnancy and the postpartum period therefore permit rigorous evaluation of putative aetiological mechanisms. 3 Of all the endocrine changes taking place after parturition, the sharp fall in circulating sex steroid hormone concentrations is perhaps most likely to contribute to the precipitation of psychosis in predisposed women. Unlike most other hormones steroids have easy access to the brain and concentrations of oestradiol and progesterone in plasma and cerebrospinal fluid are highly correlated.4 Recent research has shown that oestrogens modulate the function of monoaminergic and, in particular, dopaminergic neurotransmitter systems in the central nervous system.56 Abnormalities of dopaminergic neurotransmission have been implicated in both schizophrenic and manic depressive illness, and Cookson has proposed that puerperal psychosis is triggered by the effects of postpartum oestrogen withdrawal on central dopaminergic functions.…”

Section: Introductionmentioning

confidence: 99%

Increased sensitivity of dopamine receptors and recurrence of affective psychosis after childbirth.

Wieck

Kumar

Hirst

et al. 1991

BMJ

151

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however, made any negative comments on this issue; on the contrary, several women commented that they thought this kind of study important. Our investigation was considered and approved by all the concerned research ethics committees. CONCLUSIONS We conclude that most of the participants in this trial had been informed, but in many cases the information did not follow the guidelines of the Declaration of Helsinki. One third of the participants had not been aware that they had the option of withdrawing their participation at any time. There were systematic differences between the various participating clinics in that certain clinics were better at informing their patients than others. Our Design-Prospective study of pregnant women at high risk of developing an affective psychosis after childbirth. Clinical assessments in pregnancy and after delivery were made by using a semistructured interview (schedule for affective disorders and schizophrenia) and psychiatric illnesses were categorised according to operational criteria (research diagnostic criteria).Setting-Obstetric and psychiatric departments in and around Greater London.Subjects-29 pregnant women with a history of bipolar or schizoaffective psychosis and 47 control pregnant women. Of these, 16 from each group participated in a growth hormone challenge test and the results for 15 women in each group were analysed.Interventions-On the fourth day postpartum women participating in the hormone challenge test were given a subcutaneous injection of a small dose (0005 mg/kg) of the dopamine agonist apomorphine.Main outcome measures-Growth hormone secretion in response to apomorphine as an index of the functional state of hypothalamic dopamine receptors.Results-Eight ofthe 15 women at risk ofpsychosis subsequently had a recurrence of illness (five bipolar, one schizomanic, and two major depressive illnesses); these women had significantly greater growth hormone responses to apomorphine than the seven at risk women who remained well and the 15 controls, and there were no significant differences between groups in average baseline growth hormone concentrations. The mean (SD) concentrations for women with recurrence, women at risk who remained well, and control women respectively were: average baseline concentrations 1-06 (1.14),

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Section: Introductionmentioning

confidence: 99%