Long-term outcomes of first episode affective psychosis in postpartum women.

BACKGROUND: Outcomes of first episode postpartum psychosis and their distinction from outcomes of non-postpartum psychosis are poorly characterised. AIMS: To characterise the disease course and outcomes of first episode postpartum psychosis, compared with first episode non-postpartum psychosis. METHODS: This is a retrospective cohort study. Group demographics and subsequent outcomes were compared between groups unadjusted and adjusted for prior psychiatric illness. Outcome trajectories within the postpartum psychosis group were analysed via k-means clustering, and multivariable outcome prediction models calculated. RESULTS: Women in the postpartum group (n = 408) had lower parity (0.4 vs 0.6, t = -4.3, p < 0,001) and more prior psychiatric admissions (0.8 vs 0.1, t = 12.8, p < 0.001) than those experiencing non-postpartum psychosis (n = 1011). During follow-up, women with postpartum psychosis had fewer subsequent births and an increased risk of readmission during subsequent postpartum periods (0.55 admissions/delivery). Mortality in the postpartum group (871/100,000/year) was c. 11.3x local population norm. Clustering identified two distinct clinical trajectories following first episode postpartum psychosis, one of higher future morbidity and one of lower future morbidity. CONCLUSIONS: Small but significant differences in baseline characteristics and later prognosis were observed between individuals experiencing first episode postpartum psychosis and first episode non-postpartum psychosis in this single centre sample. Excess mortality was observed in both groups.