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PubMed1985

Offspring of women with nonorganic psychosis: mother-infant interaction at three and six weeks of age.

Mother-infant interaction during feeding and in an unstructured play situation was studied in the home at 3 weeks and 6 weeks of age in index mother-infant pairs in which the mother had a history of nonorganic psychosis (n = 42 and 51 at 3 and 6 weeks, respectively) and in demographically similar control pairs (n = 60 and 78). At both ages, interaction was significantly more negative in index than control cases, index mothers showing increased tension and a lack of harmony, decreased social contact, and reduced sensitivity to the infant's needs. Fewer significant differences were found between index and control infants. Mothers in the Schizophrenic, Cycloid and Nonendogenous groups evidenced more negative interaction characteristics than did their matched controls, but the Affective group was not in any way more negative than its controls.

Adult↗
PubMed1985

A follow-up study of post partum illness, 1946-1978.

Eighty-two patients, who were treated for post partum illness between 1946 and 1971, were identified and followed up. Diagnostically, the sample comprised unipolar depression (52%), bipolar disorder (18%), schizophrenia (16%), abnormal personality with depression (8%), organic disorder (2%), and obsessional state with depression and paranoid disorder (1% each). The overall prognosis was good, except for schizophrenia, in which more than 50% of patients had chronic disability. Further childbirth intensified, and caused deterioration of, the underlying schizophrenia process. Following an initial illness in the puerperium, the probability of a recurrent affective illness was 43% for unipolar and 66% for bipolar disorder. The risk of developing another post partum illness varied from 1 in 3 to 1 in 5 pregnancies. Five percent of the sample ultimately committed suicide, and the probable incidence of infanticide was 4%.

Adult↗
PubMed1986

Offspring of women with nonorganic psychosis: mother-infant interaction at one year of age.

Mother-infant interaction during feeding and in an unstructured play situation was studied in the home at 1 year of age in 46 index mother-infant pairs in which the mother had a history of nonorganic psychosis and in 80 demographically similar control pairs. As was true at the five previous observation ages, some aspects of the interaction were significantly more negative in index than control pairs. Index mothers showed increased tension and uncertainty regarding the infant's needs, increased physical contact during feeding and a discrepancy between the intonation and content of the mother's verbal contact with the infant. Index infants did not differ from controls in behavior in interaction. Across the entire first year, the Cycloid and Schizophrenic mothers deviated most frequently from controls, while the Affectives' interaction was more negative than controls' for the first time at the 1-year observation.

Adult↗
PubMed1986

A prospective study of postpartum psychoses in a high-risk group. 1. Clinical characteristics of the current postpartum episodes.

Postpartum psychotic episodes (PPPs) occurring during the first 6 months after delivery were prospectively studied in 88 pregnant index women with a history of nonorganic psychosis and 104 pregnant controls with no such history. While no control developed a PPP, PPPs were found following 28% of the index deliveries, almost all of these 25 cases being psychiatrically hospitalized. PPPs were especially frequent among cases with total illness diagnoses of Cycloid Psychosis and Affective Illness. More than half of the 25 cases had symptom onset within 3 weeks of delivery, and these early onset cases represented predominantly affective disorders, many of whom were manic in this episode. Cases with onset after 3 weeks were predominantly schizophrenic. Confusion was part of the current episode symptomatology in about one third of the cases and was well distributed across the different diagnostic groups.

Bipolar Disorder↗
PubMed1987

A prospective study of postpartum psychoses in a high-risk group. 2. Relationships to demographic and psychiatric history characteristics.

Among 88 reproductions to women with a history of nonorganic psychosis, 25 postpartum episodes (PPPs) occurring during the total 6-month period following the current delivery were not systematically related to the woman's demographic characteristics, to her psychiatric history characteristics surrounding onset of the previous disorder or to a history of PPPs following previous reproductions. PPPs were highly significantly related to greater length of previous psychiatric hospitalization and to active mental disturbance just prior to this pregnancy, and this was true both for PPPs developing within 3 weeks of delivery and for those developing later. Considerable differences were found in the demographic characteristics that were related to development of PPPs within these Early vs. Later Onset cases, suggesting these to represent different disorders not only diagnostically but also demographically. In several diagnostic categories, selected demographic or psychiatric history characteristics identified subgroups with PPP rates as high as 75%.

Adult↗
PubMed1988

A prospective study of postpartum psychoses in a high-risk group. 3. Relationship to mental health characteristics during pregnancy.

Within a sample of 88 pregnant women with a history of nonorganic psychosis, mental health characteristics during pregnancy, assessed prospectively through interviews and psychiatric records, were studied in relationship to the development of 25 postpartum psychotic episodes (PPPs) occurring during the first 6 months postpartum. Cases with PPP onset within 3 weeks of delivery (mostly affective or cycloid psychoses) evidenced more frequent tension-anxiety and excitement at interviews during pregnancy than did diagnostically comparable cases not developing PPPs. Cases with PPP onset later than 3 weeks postpartum (mostly schizophrenic-like psychoses) were not more frequently disturbed than were diagnostically comparable cases not developing PPPs. An absence of both affective symptoms and common fears represented a sign of increased PPP-risk in these later onset cases. The subsample of actively disturbed cases who were in contact with a psychiatrist during pregnancy were at notably increased risk for a PPP during the total 6-month period.

Affective Disorders, Psychotic↗
PubMed1988

A prospective study of postpartum psychoses in a high-risk group. 4. Relationship to life situation and experience of pregnancy.

Within a sample of 88 pregnant women with a history of nonorganic psychosis, the woman's life situation and experience of pregnancy, assessed through interviews during pregnancy, were studied in relationship to the development of 25 postpartum psychotic episodes (PPPs) occurring during the first 6 months postpartum. Neither Early nor Later Onset PPPs were associated with more current material situational problems, interpersonal difficulties, lack of relatives' support for the pregnancy, the woman's negative attitude toward the pregnancy or her experience of somatic health complaints. Contrary to expectation, PPP cases reported several more positive situational, attitudinal and experiential characteristics than did risk cases not developing PPPs. A number of different possible explanations for this finding are discussed.

Adult↗
PubMed1988

A prospective study of postpartum psychoses in a high-risk group. 5. Relationship to psychosocial aspects of labor and delivery.

Within a sample of 88 pregnant index women with a history of nonorganic psychosis, the psychosocial aspects of labor and delivery, assessed through personal observation, were studied in relation to the development of 22 postpartum psychotic episodes (PPPs) occurring during the first 6 months postpartum. As compared with index cases not developing PPPs, cases with PPP onset after 3 weeks postpartum had been significantly more anxious, had received significantly less help from the midwife, and their husbands tended to have attended the birth less often. Cases with PPP onset within 3 weeks of delivery had not been more anxious, but their husbands had been significantly more anxious and the midwives tended to have helped less. Early Onset (but not Later Onset) mothers had had slightly more frequent negative reactions towards the newborn, while the husbands in both groups tended to have been more positive towards the newborn than were other husbands.

Adaptation, Psychological↗
PubMed1988

A prospective study of postpartum psychoses in a high-risk group. 6. Relationship to birth complications and neonatal abnormality.

Somatic complications of labor and delivery and offspring abnormality were studied in relationship to the development of 24 postpartum psychotic episodes (PPPs) occurring among index women with a history of nonorganic psychosis. The 24 PPP cases were compared with 60 index cases not developing PPPs. Nonsignificant trends were found towards increased rates of induction of labor, fetal distress, instrumental deliveries and offspring abnormality among cases with PPP onset within 3 weeks of delivery. Instrumental delivery was the only complication that tended to have occurred with increased frequency among cases with PPP onset after 3 weeks.

Adaptation, Psychological↗
PubMed1988

Women with nonorganic psychosis: psychiatric and demographic characteristics of cases with versus without postpartum psychotic episodes.

Within a sample of 88 reproducing women with nonorganic psychosis, psychiatric and demographic characteristics were compared for women having only postpartum psychotic episodes (PPPs), women never having PPPs, and women having both PPPs and other psychotic episodes. Cases with only PPPs or both PPPs/other episodes most frequently had affective disorders. Cases with no PPPs most frequently had schizophrenia. Even with diagnosis controlled, cases with only PPPs were comparatively high in social class and in age at initial illness onset and were less severely ill than others. Cases with both PPPs/other episodes had the opposite characteristics. Cases never having PPPs had an intermediary position between the other two groups. PPPs in patients having only PPPs bore a special relationship to parity, not seen in other patients. PPPs appear to be associated with two different types of clinical/demographic patterns, depending upon whether the PPPs occur in isolation or as part of another illness pattern.

Adult↗
PubMed1988

A prospective study of postpartum psychoses in a high-risk group. 7. Relationship to later offspring characteristics.

Among the offspring of 88 pregnant index women with a history of nonorganic psychosis, offspring whose mothers developed postpartum psychotic episodes (PPPs) following birth (maximum n = 17) were compared with the remaining index offspring on emotional development during the first year of life, temperament characteristics during the first 2 years, and mental characteristics at 6 years of age. The maternal PPPs were not associated with any negative consequences for offspring development, and the offspring of PPP cases evidenced a number of more positive mental developmental characteristics than did other index offspring. Further comparison with offspring of normal-risk controls also supported the conclusion of no negative effect caused by maternal PPPs. Choice of an appropriate comparison group for PPP cases is discussed.

Adult↗
PubMed1990

Psychiatric morbidity among mothers attending well-baby clinic: a cross-cultural comparison.

The Self Reporting Questionnaire (SRQ), a screening instrument developed for psychiatric disorders in developing countries, was administered to 149 mothers, half of whom where non-white, attending a well-baby clinic in Manchester, United Kingdom. Psychiatric interview confirmed that high scorers on the SRQ could be given DSM-III diagnoses of anxiety and depression, but the cut-off point on SRQ for being a definite psychiatric case was found to be 7/8, higher than previous validation studies. This was the same for Asians as well as white mothers. Comparison of somatic versus psychological scores between Asian and white mothers showed no significant difference across the range of total SRQ scores. Over half of the mothers who were psychiatric cases were attending their doctors and all the Asian women doing so were attending for somatic symptoms. This study suggests that when measured in a well-baby clinic, somatic and psychological symptoms are reported equally frequently by white and Asian immigrant women in the United Kingdom but somatic symptoms predominate when Asian women consult a doctor.

Adult↗
PubMed1998

Onset of acute psychotic states in India: a study of sociodemographic, seasonal and biological factors.

This is a comparative study of patients with acute-onset, non-affective, non-organic, remitting psychoses and with non-remitting or schizophrenic psychoses in India. Two groups of patients with acute remitting and non-remitting or schizophrenic psychoses were compared with regard to the following variables: month of onset of psychosis; presence of stress, particularly fever, within 4 weeks preceding the onset of psychosis; childbirth within 12 weeks preceding the onset of psychosis; gender differences. It was found that the acute remitting psychoses showed an overrepresentation of females, a higher frequency of associated stress preceding the onset of psychosis, more often had onset during the summer months, i.e. between May and September, and had fever and childbirth preceding the onset of psychosis in a significantly higher proportion of patients, compared to acute non-remitting psychoses or schizophrenia. The implications of the findings which point towards biological factors in the aetiology of acute remitting psychoses are discussed.

Acute Disease↗
PubMed1992

Research and theory related to female reproduction: implications for clinical psychology.

Reproduction has been proposed as a cause of debilitation and psychological disturbance for centuries, recently reified through the three reproductive syndromes, the premenstrual syndrome, postnatal depression and the menopausal syndrome. The evidence for the existence of these syndromes is critically reviewed, and the different aetiological theories examined, with particular reference to biological and psychological theories. It is argued that whilst bio-medical therapies presently dominate the literature, their efficacy is questionable owing to the lack of clear evidence for a hormonal substrate underlying symptomatology. Psychological interventions are reviewed, and multifactorial or individualized interventions recommended for adoption by clinical psychologists. The role of preventative work, through education, information provision and development of self-help strategies, is discussed. It is concluded that whilst menstruation, childbirth and the menopause do not inevitably have a deleterious effect on women, and the validity of the reproductive syndromes may be questioned, reproduction does act as a salient source of attribution and is a possible contributory factor to distress. Reproduction thus needs to be considered by clinical psychologists, but not privileged above other factors which may contribute to difficulties which individual women may experience.

Arousal↗
PubMed1995

The role of the father in parental postnatal mental health.

Contrary to idealized images of parenthood, the months immediately following childbirth are characterized by enhanced rates of parental mental illness and filicide. In this paper we consider fathers and their role in the postnatal well-being of the parturient couple. The process of becoming a father is influenced by not only the man's internal and external experiences of 'father', but also the woman's, since the new infant's relationship with father is mediated by mother and her conjugal relationship with father. When a couple's prenatal relationship is based on a system of shared parental constructs involving a denigrated father and overvalued mother and a concomitant intolerance of the idea of a creative (Oedipal) couple, they will experience particular difficulties in adjusting to the new family configuration. In working with individuals or couples who have experienced post-partum psychological difficulties it is important to remember that not only maternal imagos but also paternal and conjugal ones need to be addressed.

Adult↗
PubMed1995

Depression in women: implications for health care research.

Epidemiologic data from around the world demonstrate that major depression is approximately twice as common in women than men and that its first onset peaks during the childbearing years. Progress has been made in understanding the epidemiology of depression and in developing effective treatments. Much remains to be learned about the basic pathogenesis of depression and the specific treatment needs of depressed women and their offspring, especially during the reproductive years.

Antidepressive Agents↗