BACKGROUND Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth, and the risk is particularly high in women with a history of bipolar disorder, schizoaffective disorder or in those who have suffered previous episodes of PP. While studies in patients with psychosis not related to the puerperium have demonstrated that abnormalities in stress response are important risk factors for psychosis, it remains unknown whether this is also the case for PP. METHODS This study includes 30 postpartum women, assessed, on average, at postpartum week 14.8 ± 10.1 either with a current episode of PP (n = 14), or at-risk of PP because of a history of bipolar/schizoaffective disorder but who were well (n = 16), and a group of healthy women (n = 26). Details about recent stressful life events were obtained using the List of Threatening Experiences questionnaire, while perceived stress was evaluated using the Perceived Stress Scale. We estimated hypothalamic-pituitary adrenal (HPA) activity by measuring salivary cortisol at awakening; at 15, 30, and 60 min after awakening; at noon; and at 8 pm. An Area Under the Curve analysis was performed to assess the awakening response (AUCi) and cortisol levels during the day (AUCg). Immune markers, including high sensitivity C-Reactive Protein (hs-CRP) and Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, Tumor Necrosis Factor (TNFa), Vascular Endothelial Growth Factor (VEGF), Interferon gamma (INFγ), Monocyte Chemoattractant Protein 1 (MCP-1), and Epidermal Growth Factor (EGF) were evaluated from peripheral blood samples. RESULTS Women with current PP reported more frequent recent stressful life events, and higher perceived stress than healthy women. They also showed an activation of the stress and immune response, with higher levels of cortisol AUCg and hs-CRP (but not of other inflammatory markers) than healthy controls. Women at-risk of PP who remained well had values on these measures that were intermediate between those of women with a current episode of PP and those of healthy women. Stress measures and markers of stress and immune response explained 78 % of the variance of in group status between PP and healthy women, and 46 % of variance of in group status between women at-risk and healthy women. CONCLUSION These findings suggest that an immune-HPA axis dysregulation, together with current stress may represent an important underlying pathophysiological mechanism in the onset of psychosis after childbirth in vulnerable women.

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有产后精神病风险的女性的生物应激反应：生活事件和炎症的作用

背景 产后精神病 (PP) 是与分娩相关的最严重的精神疾病，在有双相情感障碍、分裂情感障碍病史的女性或曾遭受过产后 PP 发作的女性中风险尤其高。虽然对与产褥期无关的精神病患者的研究表明，应激反应异常是精神病的重要危险因素，但尚不清楚 PP 是否也是如此。方法 本研究包括 30 名产后妇女，平均在产后 14.8 ± 10.1 周评估当前发生 PP (n = 14) 或因双相/分裂情感障碍病史而有 PP 风险但好（n = 16）和一组健康女性（n = 26）。使用威胁经历问卷列表获得有关最近压力生活事件的详细信息，而使用感知压力量表评估感知压力。我们通过测量觉醒时的唾液皮质醇来估计下丘脑-垂体肾上腺 (HPA) 的活动。醒后 15、30 和 60 分钟；中午; 晚上 8 点。进行曲线下面积分析以评估白天的觉醒反应 (AUCi) 和皮质醇水平 (AUCg)。免疫标志物，包括高灵敏度 C 反应蛋白 (hs-CRP) 和白细胞介素 (IL)-1a、IL-1b、IL-2、IL-4、IL-6、IL-8、IL-10、肿瘤坏死因子(TNFa)、血管内皮生长因子 (VEGF)、干扰素 γ (INFγ)、单核细胞趋化蛋白 1 (MCP-1) 和表皮生长因子 (EGF) 从外周血样本中进行评估。结果与健康女性相比，患有当前 PP 的女性报告了更频繁的近期压力生活事件，以及更高的压力感知。他们还表现出压力和免疫反应的激活，皮质醇 AUCg 和 hs-CRP（但不是其他炎症标志物）水平高于健康对照组。存在 PP 风险且身体状况良好的女性对这些措施的评价介于当前发生 PP 发作的女性和健康女性之间。压力测量和压力和免疫反应标记解释了 PP 和健康女性之间 78% 的群体状态差异，以及高危女性和健康女性之间 46% 的群体状态差异。结论 这些发现表明，免疫-HPA 轴失调，