Familiality of the puerperal trigger in bipolar disorder: Results of a family study
Familiality of the puerperal trigger in bipolar disorder: Results of a family study
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DOI：
10.1176/appi.ajp.158.987.913
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发表时间：
2001-06-01
影响因子：
17.7
通讯作者：
Craddock, N
中科院分区：
文献类型：
--
作者：
Jones, I;Craddock, N
目的：产褥期精神病，由分娩引起的躁狂或精神病发作，大约每1000例分娩中就有一例。临床、结果和遗传学研究的证据支持这样的假设：大多数产褥期精神病发作是一种情感性障碍素质的表现，并有产褥期诱发因素。产褥期精神病的家庭研究一致表明，精神（尤其是情感性）障碍是常见的聚集性疾病，并表明在导致产褥期精神病和双相情感障碍的家族因素中存在主要的重叠。对亲属进行直接访谈的单一大型研究表明，家庭因素在产褥期触发本身的脆弱性中起作用。作者的目的是进一步验证这一假设。方法：他们对参与正在进行的双相情感障碍兄弟姐妹分子遗传学研究的双相情感障碍多重患者家庭中产褥期精神病发作的发生率进行了研究。结果：152例双相情感障碍产妇313次分娩中有81例（26%）出现产褥期精神病发作，其中58例（38%）至少有一次产褥期精神病发作。产褥期发作聚集在家庭中。27例有一级亲属有产褥期精神病家族史的双相情感障碍产妇中，74% （N=20）发生产褥期精神病发作，而125例无此类家族史的双相情感障碍妇女中，仅有30% （N=38）发生。结论：这些结果确凿地表明，家族（可能是遗传）因素与双相情感障碍妇女产褥期发作的易感性有关。这些发现对未来的研究具有启示意义，并将在临床上用于管理考虑怀孕的双相情感障碍妇女。
Objective: Puerperal psychosis, an episode of mania or psychosis precipitated by childbirth, follows approximately one in 1,000 deliveries. The evidence of clinical, outcome, and genetic studies supports the hypothesis that the majority of puerperal psychotic episodes are manifestations of an affective disorder diathesis with a puerperal trigger. Family studies of puerperal psychosis consistently demonstrate familiar aggregation of psychiatric (particularly affective) disorder and suggest a major overlap in the familial factors predisposing to puerperal psychosis and bipolar disorder. The single large study that used direct interview of relatives suggested that familial factors play a role in vulnerability to puerperal triggering itself. The authors' goal was to test this hypothesis furtherMethod: They conducted a study of the occurrence of episodes of puerperal psychosis in families multiply affected with bipolar disorder participating in an ongoing molecular genetic study of bipolar disorder in sibling pairs.Results: Episodes of puerperal psychosis followed 81 (26%) of 313 deliveries to 152 parous women with bipolar disorder, 58 (38%) of whom had at least one puerperal psychotic episode. Puerperal episodes clustered in families. Episodes of puerperal psychosis occurred in 74% (N=20) of the 27 parous women with bipolar disorder who had a family history of puerperal psychosis in a first-degree relative but in only 30% (N=38) of the 125 women with bipolar disorder with no such family history.Conclusions: These results conclusively demonstrate that familial (probably genetic) factors are implicated in susceptibility to triggering of puerperal episodes in women with bipolar disorder. These findings have implications for future research and will be of use clinically in the management of women with bipolar disorder who are considering pregnancy.