Mental health articles

OF mental health care and mentally ill

bipolar disorder in women relationships

bipolar disorder in women relationships Though most studies do not associate an increase in antenatal manic episodes relative to nonpregnant counterparts, childbirth has long been established as the
precipitant in over one out of four manic episodes.A recent observational study showed that in women having first episodes of mania/
psychosis postdelivery, the rate of subsequent non-puerperal episodes was 69 %.Such results suggest that postpartum
may unmask bipolar diatheses in a large proportion of women. Clinical wisdom supports these findings, and women with postpartum psychosis must be armed with an understanding that ongoing management of bipolar illness may help mitigate future episodes.
Discontinuation of medication during pregnancy occurs often in women with bipolar disorder. Although it appears to carry a high risk for antenatal and postpartum relapse. A 2007 study demonstrated an overall risk of at least one mood episode in pregnancy as high as 71 % in women with bipolar disorder who had discontinued mood stabilizer treatment. Among women who discontinued mood stabilizer treatment, recurrence risk was twofold greater than their counterparts who remained on treatment. Further, the median time to first recurrence was more than fourfold shorter, and the proportion of weeks ill during pregnancy was five times
greater than subjects who continued treatment.In other words,
women with bipolar disturbance who stopped treatment tended to get sicker, faster,and took longer to stabilize than women who continued with their treatment.
In women diagnosed with bipolar disorder, between 25 % and 40 % of post partum periods are affected by an episode of mania or depression with psychotic features .The risk of postpartum psychosis in the
general population is 1 in 1,000. This risk rises to 1 in 7 in women diagnosed with bipolar disorder and an estimated 1 in 2 in women with bipolar disorder and a family history of postpartum psychosis. Even if asymptomatic, pregnant women with family histories of bipolar disorder or postpartum mood or psychotic disturbance should be considered at significant risk for postpartum psychosis and a prophylactic plan for immediate intervention should be explicit among the treatment team.
The most frightening outcomes associated to mental illness in pregnancy have been episodes of violence associated with postpartum psychosis including filicide.

It is estimated that approximately 5 % of women with postpartum psychosis will commit infanticide.Another case series showed that upwards of 73 % of women with psychosis who committed filicide were found to have underlying diagnoses of bipolar disorder .Such occurrences are tragic and terrifying, albeit rare, and harken a call to close management of all patients presenting with psychiatric symptoms in the postpartum period.

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