Clinical, cognitive, and neuroimaging correlates of risk for postpartum psychosis

Abstract

Although postpartum psychosis is a devastating and predictable disorder, it has
received little attention in biological research. This is the first study assessing
cognitive, emotional and neuroimaging correlates of women at risk of postpartum
psychosis. We hypothesised that women “at risk” will show decreased brain
activation in the dorsolateral prefrontal cortex in a working memory task and
increased brain activation in the amygdala in a facial emotion processing task,
compared to healthy controls, similar to that observed in bipolar disorder and
psychoses unrelated to childbirth.
Twenty-five women “at risk” (N=13 due to non-postpartum and N=12 due to
postpartum episodes) were compared to 21 healthy women within the first year after delivery. Women took part in two study visits including clinical interviews and a magnetic resonance imaging (MRI) scan. We assessed working memory and
emotional face processing using two functional MRI tasks and verbal memory using two behavioural tasks.
Groups were matched on sociodemographic background and medical and obstetric history. Women “at risk” showed an activation increase of the midcingulate and temporal cortices compared to healthy controls, which was accompanied by deficits in working and verbal memory performance. Women with postpartum episodes, compared to healthy controls, showed a relative increase in activation to fearful faces in the left inferior frontal gyrus.
This study provides preliminary evidence that women “at risk” of postpartum
psychosis show cognitive impairments similar to those of patients with bipolar
disorder and psychoses unrelated to childbirth. Women with postpartum episodes
seem to differ in emotional processing from healthy controls, possibly indicating an increased emotional response to fear. These results represent a first step towards a better understanding of cognitive and emotional processes in postpartum psychosis.
When validated in larger and longitudinal studies, they may help clinicians in
developing individual management strategies and implementing targeted cognitive trainings or interventions.

Date of Award	1 Apr 2014
Original language	English
Awarding Institution	King's College London
Supervisor	Paola Dazzan (Supervisor) & Mitul Mehta (Supervisor)