2 - (SYM 73) A Dimensional Approach to Perinatal Mania and Psychosis: Implications for Prevention and Intervention

Clear and compelling evidence links childbirth with heightened risk for mania and psychosis. Research is limited to perinatal women with categorical diagnoses, despite consensus that symptom distributions are fully continuous in the general population. As with perinatal depression and anxiety, subthreshold symptoms of perinatal mania and psychosis are likely to be empirically and clinically meaningful. Further, these symptoms may be missed with current screening methods. This prospective, longitudinal study examined the prevalence, course, and correlates of dimensionally-assessed symptoms of mania and psychosis in a general sample of 168 individuals giving birth for the first time.

Across 4 timepoints from late pregnancy through 2 months postpartum, symptoms were measured with validated questionnaires. At 2 months postpartum, mother-infant interaction and infant development were characterized with standardized observational protocols. Dried blood spot cytokine and hair cortisol levels were determined at 3 timepoints.

As hypothesized, mania and psychosis showed dimensionality and significant longitudinal change. Manic symptoms peaked in the immediate postpartum, while symptoms of psychosis declined from late pregnancy to 2 months postpartum. Higher scores on a mania/psychosis composite were uniquely associated with less optimal maternal behavior, after accounting for depression/anxiety and covariates. Symptoms of mania/psychosis also were associated with lower infant cognitive development, though not independent from depressive/anxiety symptoms. Regarding hormonal and immune markers, elevated symptoms of mania were uniquely related to higher interleukin-6 levels. Findings suggest that subclinical symptoms of mania and psychosis are an important yet underdetected feature of perinatal mental health in need of further attention.