A comparative study of some premorbid characteristics, clinical features and immunogram indicators in patients with postpartum psychosis and first-in-life psychotic episode

Abstract

Objective. To study and compare premorbid characteristics, clinical features, functional state of the brain according to EEG data, neuroimaging MRI characteristics and immunogram indices in patients with postpartum psychosis and first-in-life psychotic episode.

Methods. Twenty-three patients with postpartum psychotic disorders and 65 patients with a first-in-life psychotic episode were included in an open cross-sectional study. Clinical interview, general clinical impression scale, MRI, EEG and flow cytofluorimetry method were used.

Results. Women with postpartum psychosis had higher rates of nervous and endocrine system disorders (p<0.05), short duration psychotic disorders (p<0.001), affective syndrome (p<0.05), and lower relative and absolute B-lymphocyte counts (p<0.01). Abnormal levels of cytotoxic T-lymphocytes (p<0.05) and the immunoregulatory index (p<0.001) were registered more frequently in the severe course of postpartum psychosis. Among the abnormalities on MRI in patients with PP there were gliosis foci, dilation of perivascular spaces, signs of diffuse cerebral subcortical atrophy, reduced volume of the right hippocampus, enlarged subarachnoid spaces, pituitary microadenomas, and first detected volumetric masses - 61% in total. EEG of women with PP showed alpha-beta-wave dysrhythmia in 67% of cases, single bursts of low bilateral synchronous acute theta waves in 28%, pathological EEG patterns - 44%, signs of epilepsy - 17%. 

Conclusion.  The frequency of nervous and endocrine system diseases, suppression of the humoral immune system and its connection to the severity of the course of disease can testify to the active participation of immune dysregulation in the genesis of postpartum psychosis.

Key words: postpartum psychosis, first psychotic episode, premorbid characteristics, EEG, MRI, immunogram.