Clinical Presentation of Postpartum and Non‐postpartum Manic Episodes in Women with Bipolar Disorder: A Within‐subjects Analysis

Background and Aims: The relationship of postpartum psychosis to other episodes of mania occurring outside the perinatal period among women with bipolar disorder is not well understood. Previous studies have used between‐subjects designs to compare the clinical presentations of these episodes making it difficult to draw conclusions. There are also inconsistencies in the findings. To overcome this, we have undertaken within‐subject comparisons of the clinical presentation of postpartum and non‐postpartum manic episodes in women with bipolar disorder.

Method: Participants were 53 women meeting DSM‐IV for bipolar I disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org) where we had collected detailed symptom information on a postpartum episode of mania with onset within 6 weeks of childbirth and a comparison non‐postpartum manic episode The occurrence of a number manic, psychotic and depressive symptoms experienced in these episodes were compared.

Results: Postpartum manic episodes had a significantly higher incidence of perplexity (P = .004) and visual hallucinations at trend level (P = .07). In comparison more classic manic symptoms specifically racing thoughts (P = .013), pressured speech (P = .013), distractibility (P = .019), increased self‐esteem (P = .017), reduced need for sleep (P = .049) and increased sociability (P = .023) were all significantly less likely to present in postpartum episodes.

Conclusion: Differences in the clinical presentation of postpartum and non‐postpartum manic episodes within the same woman possibly suggests specific factors involved in the aetiology of postpartum mania. Further research determining if differences in these clinical presentations do reflect differences in underlying aetiology is needed. These findings could lead to improved clinical management of postpartum psychosis in women with bipolar disorder.