Brain Networks Reveal Signs of Postpartum Psychosis

One of the rare and devastating mental health problems that affect women in the first few weeks after giving birth is postpartum psychosis. The symptoms vary widely from high mood (mania), depression, confusion, hallucinations to delusions.

Women with prior history of psychiatric problems are more vulnerable, especially those having bipolar disorder or schizoaffective disorder (a condition which has symptoms of schizophrenia and bipolar disorder), or previous episodes of postpartum psychosis. It affects only one in every 1,000 mothers. The advancement of diagnosis and its mechanism remains largely unknown.

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‘Subtle differences in brain connectivity could offer a sign of risk for postpartum psychosis in women. The exact mechanisms by which these brain scan changes are related to the interaction between the mothers and their babies, and also how the babies develop during their first years of life remains to be explored further.’

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Women at risk of postpartum psychosis revealed altered connectivity in brain networks associated with 'goal-directed behaviour' - i.e. areas of the brain involved in planning, organising and completing short and long-term tasks, when compared with healthy women, as per a study at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London, and the University of Padova in Italy

This offers the first evidence that increased connectivity within the brain's executive network (responsible for attention, working memory, and decision-making) could represent a marker of resilience to postpartum psychosis relapse.

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The study was carried over among 32 women' 'at risk' of postpartum psychosis, and 27 healthy women, who were followed up from pregnancy through to eight weeks after giving birth. They were considered 'at risk' of postpartum psychosis if they had a diagnosis of bipolar disorder or schizoaffective disorder, or if they had suffered a previous episode of postpartum psychosis.

In the first four weeks after delivery, 15 women became unwell with symptoms indicating postpartum psychosis. Eight weeks after giving birth, the women had brain scans while resting, followed by further scans during an emotional processing task, to study how different brain areas were activated, and their interplay.

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Measurement of duration taken by these women to identify different facial emotions (for example, a face showing a fearful expression) and subsequent brain networks¡¦ activation was analyzed.

It was found that all women at risk of postpartum psychosis, and particularly those who later became unwell, struggled more with understanding and decoding negative emotions, compared to the healthy women. This was indicated by reduced connectivity between certain brain networks during the task and longer reaction times to the negative emotional images.

While similar connectivity changes have also been revealed in patients with other psychiatric disorders, the study found that these changes were more marked specifically in women who become unwell, potentially reflecting the emotional instability women experience during the course of the disorder.

"Although rare, postpartum psychosis is a very serious mental health problem that can be really frightening for new mothers, their partners, friends and family. Previously, it's been difficult to spot women at risk of postpartum psychosis or explain why some are more vulnerable than others, as we really haven't known enough about the neurobiology of the illness. Our study is the first step towards a better understanding of brain connectivity as a marker of vulnerability to postpartum psychosis. Higher levels of cortisol (the main stress hormone) in the third trimester of pregnancy predicted postpartum psychosis relapse. If subtle alterations in the brain's executive network, and its interaction with other brain areas, were also detectable in pregnancy, these could offer vital clues to the development of postpartum psychosis. Potentially, this could enable us to intervene earlier, allowing clinicians to provide the best possible support for new mothers, before the onset of symptoms," says Paola Dazzan, Professor of Neurobiology of Psychosis at King's College London.

The team is now planning further to study how these brain scan changes are related to the interaction between the mothers and their babies, and also how the babies develop during their first years of life.

Source-Medindia