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

• Main Author: Pauls, Astrid
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2014
• Subjects: Bipolar disorder; Magnetic resonance imaging; Medical imaging; Memory; Psychosis

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.