Exploring the connection between bipolar disorder, psychosis and childbirth

Professor Ian Jones (MSc 1997) is an Hon. Consultant Psychiatrist and a Professor of Psychiatry and Director of the National Centre for Mental Health (NCMH) at Cardiff University. His research focuses on bipolar disorder and episodes of postpartum psychosis in bipolar women. Here he explains what bipolar is, how it affects individuals, and why women are more likely to be admitted to hospital after childbirth than at any other time in their lives.

Bipolar disorder is a serious mental health condition affecting 2-5% of the population and causing severe episodes of mood disorder. People with bipolar disorder (previously referred to as manic depression) have a vulnerability to episodes of depression, but also to high episodes, or what are sometimes called manic episodes. One of the goals of our research is to try and help us understand the biological, the psychological and the social factors that lead to bipolar. This is extremely important in order for us to be able to develop better ways to predict who might be vulnerable to these episodes, intervene and develop improved treatments.

One of the ways that we’re doing that in Cardiff is by using genetic clues to try and unlock these mysteries. We’ve known for a long time that illnesses like bipolar disorder can run in families and we’re trying to identify the individual variations in people’s genes that can nudge that risk up or down. If we can identify those, and there are likely to be hundreds if not thousands of individual variations, then that will give us some real clues to the biology of this condition.

Living with bipolar disorder

We know that those people with more severe forms of bipolar, are hugely impacted in their lives. During low episodes, they can’t get out of bed, may not wash for days or weeks on end, and even think about ending their life, with suicide a tragic outcome for some with bipolar.

But they also have manic episodes. At these times, people can be elated and feel a sense of euphoria but can also be irritable and angry. They may need very little sleep and be hyperactive. These episodes of illness can cause real problems for people. They may spend money that they don’t have and get themselves into serious debt, or they may get into arguments and fall out with friends and family. About 70% of people with bipolar disorder can have psychotic symptoms as well, such as hallucinations or delusions.

What’s clear is that it takes a very long time for people with bipolar disorder to receive a diagnosis. We’ve worked with the charity Bipolar UK and found that it can take 10 years or more for people to get the right diagnosis and start on the right treatment. Bipolar is under recognised, under treated, and certainly under researched.

Talking about mental health

It’s been incredibly positive that people are prepared to talk about their mental health issues and struggles. When Stephen Fry (Hon 2010) did his documentary about bipolar disorder, Cardiff University research was featured heavily, and Stephen even volunteered his DNA – he’s now one of our research subjects. This was a massive boost in our recruitment, and people were contacting us saying that they’d heard about this important work that Cardiff was doing and wanted to help.

Cardiff has worked with a number of soap operas which featured this illness in their characters. A character called Stacey in EastEnders has a bipolar diagnosis and developed postpartum psychosis after having her baby. This had a huge impact in raising awareness of bipolar and postpartum psychosis. It was a massive help in getting the message out about these conditions, and, again, was something that really helped us in our recruitment for research.

Bipolar disorder in pregnant women

When I finished my clinical training, my first research job at Cardiff University involved travelling around the UK interviewing people with lived experience of bipolar, and what struck me was the number of women who had experienced a severe episode of illness following childbirth. It was often their first episode or first really significant episode.

Our research confirmed that having a baby strongly triggered episodes. Women are 23 times more likely to be admitted to hospital in the month after having a baby than at any other time in their lives. You don’t see those kinds of odds ratios, that size of impact, in psychiatry very often. We wanted to unpick what it is about childbirth that leads to this massive increase in risk of severe episodes.

The massive change in hormonal levels at this time may well be involved, but there are also factors that may play a role as well, sleep disruption, immunological factors and genetics for example. We’ve published research that suggests that a woman’s vulnerability to sleep disruption, and therefore circadian rhythm disruption, is a strong predictor of whether they are vulnerable to postpartum psychosis and our research supports genetic factors being key too.

Having clinicians involved in this research really helps as we can take the research findings into the clinic where they can really make a difference. It also helps strengthen the collaboration between the University and the NHS, and links us with people with lived experience of the conditions we study. This is important for recruitment, but also key to helping us understand the issues we need to target in coming up with the research questions we want to address.

Cardiff University is such a great place to do this work because you can actually turn insights into new treatments for people. And ultimately, that’s how the work will be judged in generations to come. How has this research made a difference to people who suffer with bipolar disorder and postpartum psychosis? We’re all about coming up with ways to help people with these conditions live better lives.

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