Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal psychosis. Robertson E, Jones I, Haque S, Holder R, Craddock N, Br J Psychiatry , Volume 186 (March 2005) pp.258-259.

Information about the risks of recurrence of illness is important for women who have experienced postpartum psychosis (PP), not least when planning future pregnancy.  This study looked at the rates of recurrence of illness after childbirth and illness occurring at other times in a group of 103 women following an episode of PP.

Of the 103 women, 54 had another baby and, of these women, 31 (57%) experienced another episode of PP.  Episodes of illness unrelated to childbirth were experienced by 64 (62%) of the 103 women following the original episode of PP.

Neither a personal nor a family history of bipolar episodes was a predictor of childbirth- related recurrence.  Those with a family history of bipolar disorder had a shorter time to recurrence of illness unrelated to childbirth.

The results indicate that after an episode of PP, women have a significant risk of becoming ill following a subsequent delivery (around 50%). They are also at high risk of experiencing an episode of illness unrelated to childbirth (around 60%). When making decisions about family planning therefore, it is important to be aware of the high risk of recurrence after childbirth and put appropriate plans in place, but it is equally important to know that avoiding future pregnancies may not be a guarantee of avoiding further illness. It is important to note that, women with pre-existing Bipolar Disorder might be over-represented in our sample and rates of subsequent illness might be lower in women who have only experienced a PP episode. The definition of relapse used in this study is broad and includes episodes of depression (which occur rather commonly in the general population) in addition to bipolar disorder / psychosis. Therefore the findings are complex, and require further investigation in a larger sample.