Summary
A group of 57 women, who had been hospitalised for puerperal psychiatric disorders from 1958 to 1977, were reexamined in 1982. The aim of the study was to determine the proportion of patients who had suffered from nonpuerperal psychotic relapses or other subsequent psychopathology, to define the sample diagnostically, taking into account progress in classification, to characterize the so far relatively neglected later course of illness, and to establish criteria related to relapse and global clinical outcome.
Of these patients 65% had at least one nonpuerperal relapse, only 25% remained free of later psychopathology, but the global outcome was favorable or relatively favorable in many cases. Of the patients who had had nonpuerperal relapses 43% were classified as suffering from affective psychosis, as many as 38% from schizoaffective psychosis, and only 19% from schizophrenia. Schizoaffective psychosis seems to be particularly liable to be provoked by childbirth. No major evidence was found that endogenous psychoses with puerperal onset and nonpuerperal relapses have a course of illness different from that of the corresponding diagnostic category in general. Cases with exclusively puerperal decompensations seem to be nosologically independent from the traditionally recognized endogenous psychoses. Characteristics strongly related to nonpuerperal relapses were a family history of psychosis and the occurrence of psychotic episodes before the index episode. Puerperal relapses occurred at a much higher rate in patients who also had nonpuerperal relapses than in patients without.
Zusammenfassumg
Eine Gruppe von 57 Frauen, die in der Zeit von 1958 his 1977 wegen psychischer Störungen im Puerperium hospitalisiert worden waren, wurde im Jahr 1982 nachuntersucht. Ziel der Studie war es, den Anteil von Patientinnen mit nichtpuerperalen psychotischen Rückfällen oder anderer im späteren Leben auftretender Psychopathologie zu ermitteln, die Patientinnen unter Berücksichtigung neuerer Fortschritte der psychiatrischen Klassifikation diagnostisch zu charakterisieren, den bisher wenig untersuchten weiteren Krankheitsverlauf zu beschreiben und prognostische Kriterien für Rückfälle und den weiteren globalen klinischen Verlauf zu erstellen.
65% der Patientinnen hatten nichtpuerperale Ruckfalle, und nur 25% blieben frei von jeglicher Psychopathologie, jedoch der globale klinische Verlauf war in vielen Fallen günstig oder relativ günstig. Bei 43% der Patientinnen mit nichtpuerperalen Rückfällen wurde die Diagnose einer Affektpsychose, bei 38% die einer schizoaffektiven Psychose und bei nur 19% die einer Schizophrenie gestellt. Schizoaffektive Psychosen scheinen besonders häufig durch die Geburt eines Kindes ausgelöst zu werden. Es wurden keine wesentlichen Hinweise dafür gefunden, daß endogene Psychosen mit puerperalem Beginn und nichtpuerperalen Rückfällen einen anderen langfristigen Krankheitsverlauf haben als die entsprechende diagnostische Kategorie im allgemeinen. Fälle von ausschließlich puerperalen Dekompensationen scheinen von den traditionell anerkannten endogenen Psychosen nosologisch unabhängig zu sein. Mit nichtpuerperalen Rückfällen korrelierte Charakteristika waren eine Familienanamnese von Psychosen und das Auftreten von psychotischen Störungen vor der Indexerkrankung. Puerperale Rückfälle häuften sich unter den Patientinnen, die auch nichtpuerperale Rückfälle hatten.
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Schöpf, J., Bryois, C., Jonquière, M. et al. On the nosology of severe psychiatric post-partum disorders. Eur Arch Psychiatr Neurol Sci 234, 54–63 (1984). https://doi.org/10.1007/BF00432884
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DOI: https://doi.org/10.1007/BF00432884