Perinatal Episodes Across the Mood Disorder Spectrum
Perinatal Episodes Across the Mood Disorder Spectrum
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DOI：
10.1001/jamapsychiatry.2013.279
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发表时间：
2013-02-01
期刊：
影响因子：
25.8
通讯作者：
Jones, Ian
中科院分区：
文献类型：
--
作者：
Di Florio, Arianna;Forty, Liz;Jones, Ian
背景：情感障碍在女性中很常见，许多发作在怀孕期间或产后期间发作。目的：调查患有 I 型双相情感障碍、II 型双相情感障碍和复发性重性抑郁 (RMD) 的女性围产期情绪发作的发生和时间。背景和患者：我们正在进行的关于重大情感障碍的遗传和非遗传决定因素的研究招募了女性。采访了参与者并审查了案例笔记。根据 DSM-IV 标准进行最佳估计诊断。确定的 1785 名经产妇女中，有 1212 名患有双相情感障碍的妇女（980 名患有 I 型，232 名患有 II 型）和 573 名患有 RMD。提供了 3017 名活产婴儿的数据。 主要结果指标：我们报告了围产期情绪发作的终生发生率、每次怀孕/产后的围产期发作率以及与分娩相关的发作时间。结果：超过三分之二的诊断组报告在怀孕期间或产后期间至少有 1 次终生疾病发作。患有 I 型双相情感障碍的女性报告称，每次怀孕/产后发生围产期重大情感发作的风险约为 50%。患有 RMD 或 II 型双相情感障碍的女性的风险较低，每次怀孕/产后的风险约为 40%。在 I 型双相情感障碍和 RMD 中，产后情绪发作明显更为常见。大多数围产期发作发生在产后第一个月内，躁狂或精神病比抑郁症更早发作。结论：尽管产后情绪障碍发作在 I 型双相情感障碍中更常见，并且躁狂和精神病表现发生在产后早期，但围产期发作在整个情绪障碍谱系中都非常普遍。 JAMA 精神病学。 2013；70(2)：168-175。 2012 年 12 月 17 日在线发布。doi:10.1001/jamappsychiatry.2013.279
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. JAMA Psychiatry. 2013;70(2):168-175. Published online December 17, 2012. doi:10.1001/jamapsychiatry.2013.279