情绪障碍发作与分娩有关

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。

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By: MARY ANN MOON, Ob.Gyn. News Digital Network

More than 70% of women with mood disorders who become pregnant experience at least one episode of their disorder in association with the birth or, less often, the pregnancy, according to a report published online Dec. 17 in Archives of General Psychiatry.

Given that approximately 40% of all pregnancies are unplanned, the risk of perinatal episodes of mania, hypomania, psychotic depression, and nonpsychotic major depression should be discussed with all women of childbearing age who have mood disorders, even those who are not planning a pregnancy, said Dr. Ian Jones of the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff (Wales) University and his associates.

In addition, "it is important that all professionals providing health care for pregnant women, including midwives, family physicians, and obstetricians, are aware of this increased risk," they wrote.

Dr. Jones and his colleagues assessed the occurrence of a range of psychological disorders associated with childbirth using data from two clinical and genetic studies of mood disorders. One study cohort included 573 women with recurrent major depression occurring in 1998-2004, and the other included 980 women with bipolar I disorder and 232 with bipolar II disorder occurring in 1991-2010.

Data were available regarding 3,017 pregnancies in 1,410 of these women. The prevalence of episodes of mania, hypomania, depression with psychosis, or nonpsychotic major depression either during pregnancy or within 1 year of childbirth was similar across the spectrum of mood disorders: 70.8% for bipolar I disorder, 70.9% for bipolar II disorder, and 73.7% for recurrent major depression.

"The importance of pregnancy and childbirth for women with mood disorders should therefore not be underestimated," the investigators said (Arch. Gen. Psychiatry 2012 Dec. 17 [doi:10.1001/jamapsychiatry.2013.279]).

In this sample, 94% of the episodes of mania or psychotic depression occurred within 4 weeks postpartum.

For women with bipolar I disorder, approximately 20% of deliveries were associated with a postpartum episode of mania or psychotic depression and an additional 25% were associated with an episode of nonpsychotic major depression. Altogether, nearly half of the deliveries in women with bipolar I disorder were associated with "an episode of a major mood disorder of some description," Dr. Jones and his associates reported.

Although the rate of such episodes was lower for both bipolar II disorder and recurrent major depression, "it would be wrong to underestimate the importance" of such episodes in these patient populations, they said. Approximately 40% of deliveries among women with bipolar II disorder or major recurrent depression were associated with episodes of these disorders.

Only a small proportion of psychotic or depressive episodes occurred during pregnancy rather than postpartum in this sample. The rate, however, was roughly twice as high in women with bipolar II disorder (18.4%) than in those with bipolar I disorder (8.6%) or recurrent major depression (11%).

The relatively few episodes of psychosis or depression that developed during pregnancy were equally distributed across the three trimesters.

Similarly, less than 4% of all episodes of psychosis or depression occurred after 6 months postpartum, and the rates were similar across the three types of mood disorder, Dr. Jones and his associates said.

This study was supported by the Wellcome Trust, the Stanley Medical Research Institute, and the Welsh Assembly Government Health Studentship. No financial conflicts were reported.