The relationship between duration of labour, time of delivery, and puerperal psychosis

Background: Puerperal psychosis is the most serious psychiatric disorder after childbirth. Despite the ongoing debate regarding its diagnostic status, there is increasing evidence that it is related to bipolar or schizoaffective disorder. Although a well-recognized precipitant of mania, the role of sleep loss has not been systematically studied in the onset of puerperal psychosis. The aim of this study was to test the hypothesis that sleep disruption resulting from longer labour or nighttime delivery would be associated with the onset of puerperal psychosis. Method: Data on duration of labour and time of delivery were compared between a group of patients who were hospitalized with a diagnosis of puerperal psychosis and a group of controls from the same hospitals that were matched on age, parity, and on year of admission to the hospital. Results: The most common DSM-lV diagnoses were bipolar disorder or schizoaffective disorder. The women in the puerperal psychosis group had a longer duration of labour and were more likely to have a nighttime delivery compared to women in the control group. Insomnia was the most frequent and usually the earliest symptom. Limitations: Small sample size, chart review, no direct measure of sleep, and use of a normal control rather than a comparison group of at-risk women. Conclusions: These preliminary findings provide indirect evidence that sleep loss may be a precipitant of puerperal psychosis in women who are biologically predisposed to this illness. Declaration of interest: This research was supported by the Ontario Mental Health Foundation. (C) 2004 Elsevier B.V. All rights reserved.