ARCH GEN PSYCHIAT :情绪障碍发作与分娩有关

2012-12-21 ARCH GEN PSYCHIAT 网络 EGMN

    根据在线发表于12月17日的《普通精神病学文献》上的一篇报告,伴有情绪障碍的妊娠妇女70%以上发生至少1次与分娩相关的情绪障碍发作,与妊娠相关的情绪障碍发作相对较少。   威尔士Cardiff大学精神药物和临床神经科学研究所的Ian Jones医生及其同事利用来自两项关于情绪障碍的临床和遗传学研究的数据,评估了与分娩相关的多种精神障碍的发生情况。一个研究队列中纳入

分娩
 

  根据在线发表于12月17日的《普通精神病学文献》上的一篇报告,伴有情绪障碍的妊娠妇女70%以上发生至少1次与分娩相关的情绪障碍发作,与妊娠相关的情绪障碍发作相对较少。

  威尔士Cardiff大学精神药物和临床神经科学研究所的Ian Jones医生及其同事利用来自两项关于情绪障碍的临床和遗传学研究的数据,评估了与分娩相关的多种精神障碍的发生情况。一个研究队列中纳入573例于1998~2004年间有复发性重度抑郁症的女性患者,另一个队列中纳入980例于1991~2010年间发生双相Ⅰ障碍女性患者和232例双相Ⅱ障碍的女性患者。共获得其中1,410例女性的3,017次妊娠的数据。

  结果显示,妊娠期间或分娩后1年内,躁狂、轻躁狂、抑郁症伴精神病或非精神病重度抑郁症发作的患病率在各种情绪障碍谱中相似:双相Ⅰ障碍为70.8%,双相Ⅱ障碍为70.9%,复发性重度抑郁症为73.7%。在这个样本中,94%的躁狂或精神病性抑郁症发作是发生于产后4周内。对于双相Ⅰ障碍女性,大约20%的分娩与产后躁狂或精神病性抑郁症发作相关,另外25%与非精神病重度抑郁症发作相关。总之,在双相Ⅰ障碍女性中,接近半数的分娩与“某些重度情绪障碍发作”相关,Jones博士及其合作者报告。尽管此类发作的发生率低于双相Ⅱ障碍和复发性重度抑郁症,“也不可以低估”此类发作对于这一患者群体的重要意义。在双相Ⅱ障碍或重度复发性抑郁症女性患者中,大约40%的分娩与此类障碍发作相关。在这一样本中,仅有很小比例的精神病或抑郁发作发生于妊娠期间,而非产后。但双相Ⅱ障碍女性患者的发生率(18.4%)约为双相Ⅰ障碍(8.6%)和复发性重度抑郁症患者(11%)的2倍。相对较少的孕期精神病或抑郁症发作均衡分布于早、中、晚三个孕期。相似的,所有精神病或抑郁症发作中仅有不足4%发生于产后6个月之后,并且在3种类型情绪障碍组中的发生率相似,Jones博士及其合作者说。

  研究者总结认为,情绪障碍发作与妊娠和分娩之间存在关联,因此“不可低估妊娠和分娩对于情绪障碍女性患者的重要性”。(Arch. Gen. Psychiatry 2012 Dec. 17 [doi:10.1001/jamapsychiatry.2013.279])。

  这项研究由Wellcome Trust、Stanley医学研究所和威尔士议会政府卫生奖学金资助。作者未披露任何利益冲突。


Perinatal Episodes Across the Mood Disorder Spectrum 

Context  

Affective disorders are common in women, with many episodes having an onset in pregnancy or during the postpartum period.

Objective  

To investigate the occurrence and timing of perinatal mood episodes in women with bipolar I disorder, bipolar II disorder, and recurrent major depression (RMD).

Setting and Patients  

Women were recruited in our ongoing research on the genetic and nongenetic determinants of major affective disorders. Participants were interviewed and case notes were reviewed. Best-estimate diagnoses were made according to DSM-IV criteria. The 1785 parous women identified included 1212 women with bipolar disorder (980 with type I and 232 with type II) and 573 with RMD. Data were available on 3017 live births.

Main Outcome Measures  

We report the lifetime occurrence of perinatal mood episodes, the rates of perinatal episodes per pregnancy/postpartum period, and the timing of the onset of episodes in relation to delivery.

Results  

More than two-thirds of all diagnostic groups reported at least 1 lifetime episode of illness during pregnancy or the postpartum period. Women with bipolar I disorder reported an approximately 50% risk of a perinatal major affective episode per pregnancy/postpartum period. Risks were lower in women with RMD or bipolar II disorder, at approximately 40% per pregnancy/postpartum period. Mood episodes were significantly more common in the postpartum period in bipolar I disorder and RMD. Most perinatal episodes occurred within the first postpartum month, with mania or psychosis having an earlier onset than depression.

Conclusions  

Although episodes of postpartum mood disorder are more common in bipolar I disorder and manic and psychotic presentations occur earlier in the postpartum period, perinatal episodes are highly prevalent across the mood disorder spectrum.

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