Postpartum psychosis (PP) is a severe perinatal psychiatric disorder which occurs in 1-2 per 1000 people after delivery and lacks a clear definition and any agreed-upon diagnostic criteria. Some patients with PP experience recurrent episodes of mania/hypomania and/or depression, while others do not manifest recurrent manic or psychotic illness beyond the postpartum period. PP has a significant overlap with bipolar disorder, although the diagnosis does not fully encapsulate PP. Understanding the presentation and treatment of PP will inform clinical decisions in this population.
The Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) was established in 2018 to understand the experience of PP in a large, diverse cohort of patients across the United States and internationally. MGHP3 also aims to identify genomic and clinical risk factors for PP. Individuals are eligible to participate in MGHP3 if they are over 18 years old; speak English; and experienced a psychotic episode within 6 months of a live birth, still birth, or intrauterine fetal demise within the past 10 years. Patients are excluded if they have a history of a psychotic disorder without mood symptoms before the postpartum period or have a history of substance use (besides marijuana) within one year postpartum. As of July 1, 2022, 311 subjects were enrolled in MGHP3 from 7 countries, 44 states, and Washington D.C.
Participants complete an approximately 90-minute phone interview which includes the Massachusetts General Hospital Postpartum Psychosis Project Questionnaire, the Childhood Trauma Questionnaire and Recent Trauma Events Scale, and the Mini International Neuropsychiatric Interview for Psychotic Disorders Studies, which is used to establish psychiatric diagnoses and describe psychotic symptoms during the postpartum period. Following the study interview, participants complete a saliva sample, which will be processed for genome-wide analysis at the MGH Core Laboratory. A subgroup of MGHP3 participants and a comparison of healthy women who did not experience psychiatric symptoms after delivery have participated in a neuroimaging assessment using functional magnetic resonance imaging (fMRI) scans to look for abnormalities in brain structure or function. We hope that a better understanding of the clinical presentation of and genetic contributions to PP can enhance the identification and treatment of this disorder.
Citation: Cohen LS, Vanderkruik R, Arakelian M, Church TR, Dunk MM, Freeman MP. Establishment of the MGH Postpartum Psychosis Project: MGHP3. PLoS One. 2023 Feb 9;18(2):e0281133. doi: 10.1371/journal.pone.0281133. PMID: 36758024; PMCID: PMC9910633.
Written by Peri Barest, Clinical Research Coordinator