<p>In the nineteenth century, the estimated prevalence of puerperal mania varied from 1 in 80–800 deliveries.<span><sup>1</sup></span> The literature from this era is replete with clinical accounts of puerperal mania and melancholia in women admitted to Victorian asylums. Changes in the nosology and interpretation of postpartum psychiatric disorder in the 20th century have produced lower rates of postpartum mania. For example, some cases of puerperal mania would be diagnosed as delirium or a toxic confusional state in today's terminology. Other factors have contributed to waning interest in puerperal mania. Coinciding with the deinstitutionalization process of replacing long-stay psychiatric hospitals with community mental health services, the research focus shifted from the study of severe psychopathology to commonly encountered conditions in the community such as baby blues and postpartum depression. The term third-day depression after childbirth, also known as the baby blues, was first described in 1952 but has a larger share of literature than postpartum mania. An ‘unofficial’ but popular nomenclature includes baby blues, postpartum depression, and postpartum psychosis but makes no direct mention of manic or mixed episodes. Postpartum psychosis denotes disparate conditions including brief psychotic disorder, manic or mixed episodes with or without psychotic features, and major depressive episodes with psychosis.<span><sup>2</sup></span> The usurping of manic and mixed episodes by postpartum psychosis likely led to a lack of interest in the study of postpartum mania as shown in Figure 1.</p><p>Of mood and anxiety disorders, bipolar disorder carries the highest risk of recurrence in the postpartum period. Studies over the last few decades have demonstrated that postpartum bipolar disorder is common in community and clinical settings. A study of 10.000 women from the US found that approximately 14% of women screened positive for postpartum depression. Of those who screened positively, 23% had bipolar disorder, the most common type being bipolar I disorder (49.7%).<span><sup>3</sup></span> This means that approximately 1.6% of women in the community have a bipolar I mood episode after delivery. A recent study estimated that 39% of women with bipolar I disorder have a postpartum relapse. Of those with a postpartum relapse, 38% had a manic or mixed episode yielding an estimated prevalence of 14.82% among women with bipolar I disorder.<span><sup>4</sup></span> This is likely an underestimate because mania can occur spontaneously in the absence of psychiatric illness. As a comparison, the global prevalence of postpartum psychosis is only 0.089 to 2.6 per 1000 births.<span><sup>5</sup></span></p><p>Detecting, diagnosing, and treating manic or mixed episodes in the postpartum period is challenging. Owing to their onset typically within the first few weeks following childbirth, and the lack of information about the timing of the onset of “postpartum” ep
{"title":"Let us not forget postpartum manic or mixed episodes","authors":"Verinder Sharma","doi":"10.1111/bdi.13479","DOIUrl":"10.1111/bdi.13479","url":null,"abstract":"<p>In the nineteenth century, the estimated prevalence of puerperal mania varied from 1 in 80–800 deliveries.<span><sup>1</sup></span> The literature from this era is replete with clinical accounts of puerperal mania and melancholia in women admitted to Victorian asylums. Changes in the nosology and interpretation of postpartum psychiatric disorder in the 20th century have produced lower rates of postpartum mania. For example, some cases of puerperal mania would be diagnosed as delirium or a toxic confusional state in today's terminology. Other factors have contributed to waning interest in puerperal mania. Coinciding with the deinstitutionalization process of replacing long-stay psychiatric hospitals with community mental health services, the research focus shifted from the study of severe psychopathology to commonly encountered conditions in the community such as baby blues and postpartum depression. The term third-day depression after childbirth, also known as the baby blues, was first described in 1952 but has a larger share of literature than postpartum mania. An ‘unofficial’ but popular nomenclature includes baby blues, postpartum depression, and postpartum psychosis but makes no direct mention of manic or mixed episodes. Postpartum psychosis denotes disparate conditions including brief psychotic disorder, manic or mixed episodes with or without psychotic features, and major depressive episodes with psychosis.<span><sup>2</sup></span> The usurping of manic and mixed episodes by postpartum psychosis likely led to a lack of interest in the study of postpartum mania as shown in Figure 1.</p><p>Of mood and anxiety disorders, bipolar disorder carries the highest risk of recurrence in the postpartum period. Studies over the last few decades have demonstrated that postpartum bipolar disorder is common in community and clinical settings. A study of 10.000 women from the US found that approximately 14% of women screened positive for postpartum depression. Of those who screened positively, 23% had bipolar disorder, the most common type being bipolar I disorder (49.7%).<span><sup>3</sup></span> This means that approximately 1.6% of women in the community have a bipolar I mood episode after delivery. A recent study estimated that 39% of women with bipolar I disorder have a postpartum relapse. Of those with a postpartum relapse, 38% had a manic or mixed episode yielding an estimated prevalence of 14.82% among women with bipolar I disorder.<span><sup>4</sup></span> This is likely an underestimate because mania can occur spontaneously in the absence of psychiatric illness. As a comparison, the global prevalence of postpartum psychosis is only 0.089 to 2.6 per 1000 births.<span><sup>5</sup></span></p><p>Detecting, diagnosing, and treating manic or mixed episodes in the postpartum period is challenging. Owing to their onset typically within the first few weeks following childbirth, and the lack of information about the timing of the onset of “postpartum” ep","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 6","pages":"529-531"},"PeriodicalIF":5.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marc J. Weintraub, John A. Merranko, Megan C. Ichinose, Danielle M. Denenny, Patricia D. Walshaw, Georga Morgan-Fleming, Robin D. Brown, Armen C. Arevian, David J. Miklowitz