Top

BMC Psychiatry

Published in:

Open Access 01-12-2019 | Research article

Postpartum psychosis in bipolar disorder: no evidence of association with personality traits, cognitive style or affective temperaments

Authors: A. Perry, K. Gordon-Smith, I. Webb, E. Fone, A. Di Florio, N. Craddock, I. Jones, L. Jones

Published in: BMC Psychiatry | Issue 1/2019

Abstract

Background

Bipolar disorder has been associated with several personality traits, cognitive styles and affective temperaments. Women who have bipolar disorder are at increased risk of experiencing postpartum psychosis, however little research has investigated these traits and temperaments in relation to postpartum psychosis. The aim of this study is to establish whether aspects of personality, cognitive style and affective temperament that have been associated with bipolar disorder also confer vulnerability to postpartum psychosis over and above their known association with bipolar disorder.

Methods

Personality traits (neuroticism, extraversion, schizotypy and impulsivity), cognitive styles (low self-esteem and dysfunctional attitudes) and affective temperaments (including cyclothymic and depressive temperaments) were compared between two groups of parous women with DSM-IV bipolar I disorder: i) 284 with a lifetime history of postpartum psychosis within 6 weeks of delivery (PP group), ii) 268 without any history of mood episodes with onset during pregnancy or within 6 months of delivery (no perinatal mood episode, No PME group).

Results

After controlling for current mood state, and key demographic, clinical and pregnancy-related variables, there were no statistically significant differences between the PP and No PME groups on any of the personality, cognitive style or affective temperament measures.

Conclusions

Personality traits, cognitive styles and affective temperaments previously shown to be associated with bipolar disorder in general were not specifically associated with the occurrence of postpartum psychosis. These factors may not be relevant for predicting risk of postpartum psychosis in women with bipolar disorder.

Akiskal HS, Akiskal KK, Haykal RF, Manning JS, Connor PD. TEMPS-A: progress towards validation of a self-rated clinical version of the temperament evaluation of the Memphis, Pisa, Paris, and San Diego autoquestionnaire. J Affect Disord. 2005;85(1):3–16.PubMedCrossRef

Altman EG, Hedeker D, Peterson JL, Davis JM. The altman self-rating mania scale. Biol Psychiatry. 1997;42(10):948–55.PubMedCrossRef

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edi. Washington, DC: American Psychiatric Association; 2000.

Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.

Benazzi F, Akiskal HS. A downscaled practical measure of mood lability as a screening tool for bipolar II. J Affect Disord. 2005;84(2):225–32.PubMedCrossRef

Bergink V, Burgerhout KM, Weigelt K, Pop VJ, de Wit H, Drexhage RC, et al. Immune system Dysregulation in first-onset postpartum psychosis. Biol Psychiatry. 2013;73(10):1000–7.PubMedCrossRef

Bergink V, Kushner SA, Pop V, Kuijpens H. Lambregtse-van Den berg MP, Drexhage RC, et al. prevalence of autoimmune thyroid dysfunction in postpartum psychosis. Br. J. Psychiatry. 2011;198(4):264–8.

Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology of postpartum depression. Compr. Psychiatry. 2003:234–46.PubMedCrossRef

Brockington IF, Martin C, Brown GW, Goldberg D, Margison F. Stress and puerperal psychosis. Br J Psychiatry. 1990;157(3):331–4.PubMedCrossRef

10.

Cassano GB, Akiskal HS, Savino M, Musetti L, Perugi G. Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. J Affect Disord. 1992;26(2):127–40.PubMedCrossRef

11.

Di Florio A, Hamshere M, Forty L, Green EK, Grozeva D, Jones I, et al. Affective temperaments across the bipolar-unipolar spectrum: examination of the TEMPS-A in 927 patients and controls. J Affect Disord. 2010;123(1):42–51.PubMedCrossRef

12.

Di Florio A, Jones L, Forty L, Gordon-Smith K, Robertson Blackmore E, Heron J, et al. Mood disorders and parity - a clue to the aetiology of the postpartum trigger. J Affect Disord. 2014;152–154(1):334–9.PubMedPubMedCentralCrossRef

13.

Di Florio A, Smith S, Jones I. Postpartum psychosis. Obstet Gynaecol. 2013;15(3):145–50.

14.

Dowlatshahi D, Paykel ES. Life events and social stress in puerperal psychoses: absence of effect. Psychol Med. 1990;20(3):655–62.PubMedCrossRef

15.

Evans L, Akiskal HS, Keck PE, McElroy SL, Sadovnick AD, Remick RA, et al. Familiality of temperament in bipolar disorder: support for a genetic spectrum. J Affect Disord. 2005;85(1):153–68.PubMedCrossRef

16.

Eysenck HJ, Eysenck SB. Manual for the Eysenck personality questionnaire. (EPQ-R adult). London: Hodder and Stoughton; 1975.

17.

Fletcher K, Parker G, Barrett M, Synnott H, McCraw S. Temperament and personality in bipolar II disorder. J Affect Disord. 2012;136(3):304–9.PubMedCrossRef

18.

Gale CR, Hagenaars SP, Davies G, Hill WD, Liewald DCM, Cullen B, et al. Pleiotropy between neuroticism and physical and mental health: findings from 108 038 men and women in UK biobank. Transl Psychiatry. 2016;6(4):e791.PubMedPubMedCentralCrossRef

19.

Hantouche EG, Akiskal HS, Lancrenon S, Allilaire JF, Sechter D, Azorin JM, et al. Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a french national multi-site study (EPIDEP). J Affect Disord. 1998;50(2):163–73.PubMedCrossRef

20.

Hayes JF, Osborn DPJ, Lewis G, Dalman C, Lundin A. Association of Late Adolescent Personality with Risk for subsequent serious mental illness among men in a Swedish Nationwide cohort study. JAMA Psychiat. 2017;74(7):703–11.CrossRef

21.

Henna E, Hatch JP, Nicoletti M, Swann AC, Zunta-Soares G, Soares JC. Is impulsivity a common trait in bipolar and unipolar disorders? Bipolar Disord. 2013;15(2):224–7.CrossRef

22.

Heron J, Jones I, Williams J, Owen MJ, Craddock N, Jones LA. Self-reported schizotypy and bipolar disorder: demonstration of a lack of specificity of the kings Schizotypy questionnaire. Schizophr Res. 2003;65(2):153–8.PubMedCrossRef

23.

Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry. 2001;158(6):913–7.PubMedCrossRef

24.

Jones I, Craddock N. Do puerperal psychotic episodes identify a more familial subtype of bipolar disorder? Results of a family history study. Psychiatr Genet. 2002;12(3):177–80.PubMedCrossRef

25.

Jones I, Craddock N. Bipolar disorder and childbirth: the importance of recognising risk. Br J Psychiatry. 2005;186(6):453–4.PubMedCrossRef

26.

Jones I, Hamshere M, Nangle JM, Bennett P, Green E, Heron J, et al. Bipolar affective puerperal psychosis: genome-wide significant evidence for linkage to chromosome 16. Am J Psychiatry. 2007;164(7):1099–104.PubMedCrossRef

27.

Jones I, Smith S. Puerperal psychosis: identifying and caring for women at risk. Adv Psychiatr Treat. 2009;15(6):411–8.CrossRef

28.

Jones L, Scott J, Cooper C, Forty L, Smith KG, Sham P, et al. Cognitive style, personality and vulnerability to postnatal depression. Br J Psychiatry. 2010;196(3):200–5.PubMedCrossRef

29.

Jones LA, Cardno AG, Murphy KC, Sanders RD, Gray MY, McCarthy G, et al. The kings Schizotypy questionnaire as a quantitative measure of schizophrenia liability. Schizophr Res. 2000;45(3):213–21.PubMedCrossRef

30.

Klein MH, Wonderlich S, Shea MT. Models of relationships between personality and depression: Toward a framework for theory and research. Personal. Depress. New York: Guilford Press; 1993. p. 1–54.

31.

Langan Martin J, McLean G, Cantwell R, Smith DJ. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study. BMJ Open. 2016;6(1):e008758.PubMedPubMedCentralCrossRef

32.

Lewis KJS, Di Florio A, Forty L, Gordon-Smith K, Perry A, Craddock N, et al. Mania triggered by sleep loss and risk of postpartum psychosis in women with bipolar disorder. J Affect Disord. 2018;225:624–9.PubMedCrossRef

33.

Marks MN, Wieck A, Checkley SA, Kumar R. Contribution of psychological and social factors to psychotic and non-psychotic relapse after childbirth in women with previous histories of affective disorder. J Affect Disord. 1992;24(4):253–63.PubMedCrossRef

34.

McNeil TF, Persson-Blennow I, Binett B, Harty B, Karyd U. A prospective study of postpartum psychoses in a high-risk group: 7. Relationship to later offspring characteristics. Acta Psychiatr. Scand. 1988;78:613–7.

35.

Mendlowicz MV, Jean-Louis G, Kelsoe JR, Akiskal HS. A comparison of recovered bipolar patients, healthy relatives of bipolar probands, and normal controls using the short TEMPS-A. J Affect Disord. 2005;85(1):147–51.PubMedCrossRef

36.

Nowakowska C, Strong CM, Santosa CM, Wang PW, Ketter TA. Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. J Affect Disord. 2005;85(1):207–15.PubMedCrossRef

37.

Patton JH, Stanford MS, Barratt ES. Factor structure of the barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768–74.PubMedCrossRef

38.

Peluso MAM, Hatch JP, Glahn DC, Monkul ES, Sanches M, Najt P, et al. Trait impulsivity in patients with mood disorders. J Affect Disord. 2007;100(1):227–31.PubMedCrossRef

39.

Perry A, Gordon-Smith K, Di Florio A, Forty L, Craddock N, Jones L, et al. Adverse childhood life events and postpartum psychosis in bipolar disorder. J Affect Disord. 2016;205:69–72.PubMedCrossRef

40.

Power MJ, Katz R, McGuffin P, Duggan CF, Lam D, Beck AT. The dysfunctional attitude scale (DAS). A comparison of forms a and B and proposals for a new subscaled version. J Res Pers. 1994;28(3):263–76.CrossRef

41.

Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965.CrossRef

42.

Sanches M, Scott-Gurnell K, Patel A, Caetano SC, Zunta-Soares GB, Hatch JP, et al. Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Compr Psychiatry. 2014;55(6):1337–41.PubMedPubMedCentralCrossRef

43.

Sariusz-Skapska M, Czabala C, Dudek D, Zieba A, Rduch S. Personality traits in patients with unipolar and bipolar disorder. Psychiatr Pol. 2003;37(2):225–33.PubMed

44.

Savitz J, van der Merwe L, Ramesar R. Dysthymic and anxiety-related personality traits in bipolar spectrum illness. J Affect Disord. 2008;109(3):305–11.PubMedCrossRef

45.

Smillie LD, Bhairo Y, Gray J, Gunasinghe C, Elkin A, McGuffin P, et al. Personality and the bipolar spectrum: normative and classification data for the Eysenck personality questionnaire-revised. Compr Psychiatry. 2009;50(1):48–53.PubMedCrossRef

46.

Solmi M, Zaninotto L, Toffanin T, Veronese N, Lin K, Stubbs B, et al. A comparative meta-analysis of TEMPS scores across mood disorder patients, their first-degree relatives, healthy controls, and other psychiatric disorders. J Affect Disord. 2016;196:32–46.PubMedCrossRef

47.

Swann AC, Anderson JC, Dougherty DM, Moeller FG. Measurement of inter-episode impulsivity in bipolar disorder. Psychiatry Res. 2001;101(2):195–7.PubMedCrossRef

48.

Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157(2):179–84.PubMedCrossRef

49.

Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJM, Kushner SA, Bergink V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am J Psychiatry. 2016;173(2):117–27.PubMedCrossRef

50.

Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, et al. SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry. 1990. p. 589–593.PubMedCrossRef

51.

Wisner KL, Peindl KS, Hanusa BH. Psychiatric episodes in women with young children. J Affect Disord. 1995;34(1):1–11.PubMedCrossRef

52.

World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. 10th Revis ed. Geneva: World Health Organization; 1993.

Title: Postpartum psychosis in bipolar disorder: no evidence of association with personality traits, cognitive style or affective temperaments
Authors: A. Perry
K. Gordon-Smith
I. Webb
E. Fone
A. Di Florio
N. Craddock
I. Jones
L. Jones
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-019-2392-0

At a glance: The STEP trials

Springer Medicine

Postpartum psychosis in bipolar disorder: no evidence of association with personality traits, cognitive style or affective temperaments

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

High level of pattern glare in major depressive disorder

Promoting early autism detection and intervention in underserved communities: study protocol for a pragmatic trial using a stepped-wedge design

The decision tool unipolar depression (DTUD): a new measure to facilitate the early identification of patients with major depressive disorder in need of highly specialized care

Implicit affectivity in clinically depressed patients during acute illness and recovery

SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging

Comorbid tobacco and other substance use and symptoms of anxiety and depression among hospitalised orthopaedic trauma patients