The aetiology and result of affective psychosis caused by childbirth

Project summary

Childbirth has the highest relative risk of any vulnerability factor associated with the onset of severe psychiatric illness. Postpartum psychosis is the most severe form of pregnancy-related psychiatric illness. Unfortunately, the pathophysiology underlying postpartum psychosis remains uncertain. In our recent work, we have identified monocyte inflammatory activation in postpartum psychosis. In a small sample, we found a high prevalence of autoimmune thyroid disease and pre-eclampsia, further suggestive of an (auto) inflammatory condition. Moreover, we observed that severe postpartum psychiatric episodes can be prevented by the use of lithium, an anti-inflammatory drug. We plan to investigate epidemiologically: 

1. The co-occurrence of postpartum psychiatric episodes and immune disorders. Identification of the sequential occurrence or co-occurrence of these two disorders could provide a solid ground on which toproceedclinically and in translational research studies. 
2.  Pharmacological treatment during pregnancy and subsequent risk of psychiatric episodes in women at high risk, to provide guidance to physicians regarding the optimal time-course and dosing of medication to prevent postpartum psychosis. 

This proposal builds directly on accessibility to a platform of invaluable information within the Danish population-based registry of 4.4 million births, thereby providing the necessary statistical power to investigate lower-incidence disorders such as postpartum psychosis. 

The study will greatly extend our understanding of how prenatal and childhood adversities induce neurodevelopmental vulnerability and increase the depression risk. This study will improve clinical practice as it investigates resilience factors buffering against adversity and sensitive periods guiding interventions.