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      The role of the immune system in postpartum psychosis

      research-article
      Brain, Behavior, & Immunity - Health
      Elsevier
      Postpartum psychosis, Immune system, Inflammation, Biomarkers, Perinatal period

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          Abstract

          Postpartum psychosis is the most severe psychiatric disorder associated with childbirth. The risk is particularly high for women with a history of bipolar disorder or schizoaffective disorder, or those who have suffered a previous episode of postpartum psychosis. However, the aetiology of the illness remains unclear. Pregnancy and the early postpartum are times of significant immunological change. Furthermore, alterations to the immune system have been implicated in the onset and course of various psychopathologies, both related and unrelated to childbirth. Emerging evidence, from studies on immune related disorders, immune cells and inflammatory markers, suggests that the immune system might also be involved in the pathophysiology of postpartum psychosis. Furthermore, recent research has also begun to explore the potential mechanisms underlying immune dysfunction in postpartum psychosis (e.g., disturbances in the Treg–CCN3 protein–(re)myelination axis). Nevertheless, more research is required to understand whether immune dysfunction is a cause or consequence of postpartum psychosis and to clarify the exact mechanisms involved. The aim of this short review is to present the current findings on immune system dysregulation in postpartum psychosis, discuss possible mechanisms underlying the association, highlight potential challenges and confounders and provide suggestions for future research.

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          The unique immunological and microbial aspects of pregnancy

          Although healthy pregnancies were traditionally considered to require an anti-inflammatory state, emerging evidence suggests that inflammation is important for a healthy pregnancy. Here, the authors discuss how the immune response varies throughout the main stages of pregnancy, and they consider how bacterial and viral infections can affect immune responses at the maternal–fetal interface.
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            Inflammation and pregnancy: the role of the immune system at the implantation site.

            The concept that pregnancy is associated with immune suppression has created a myth of pregnancy as a state of immunological weakness and, therefore, of increased susceptibility to infectious diseases. A challenging question is whether the maternal immune system is a friend or a foe of pregnancy. In this review, we discuss data associated to the role of the immune system during pregnancy. We propose a new paradigm in terms of the fetal-maternal immune interaction as well as the immunological response of the mother to microorganism. Our challenge is to better understand the immunology of pregnancy in order to deliver the appropriate treatment to patients with pregnancy complications as well as to determine public policies for the protection of pregnant women during pandemics. © 2011 New York Academy of Sciences.
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              Association of Serum Interleukin 6 and C-Reactive Protein in Childhood With Depression and Psychosis in Young Adult Life : A Population-Based Longitudinal Study

              Longitudinal studies have linked the systemic inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP) with the risk of developing heart disease and diabetes mellitus, which are common comorbidities for depression and psychosis. Recent meta-analyses of cross-sectional studies have reported increased serum levels of these inflammatory markers in depression, first-episode psychosis, and acute psychotic relapse; however, the direction of the association has been unclear. To test the hypothesis that higher serum levels of IL-6 and CRP in childhood would increase future risks for depression and psychosis. The Avon Longitudinal Study of Parents and Children (ALSPAC)is a prospective general population birth cohort study based in Avon County, England. We have studied a subsample of approximately 4500 individuals from the cohort with data on childhood IL-6 and CRP levels and later psychiatric assessments. Levels of IL-6 and CRP were measured in nonfasting blood samples obtained in participants at age 9 years. Participants were assessed at age 18 years. Depression was measured using the Clinical Interview Schedule-Revised (CIS-R) and Mood and Feelings Questionnaire (MFQ), thus allowing internal replication; psychotic experiences (PEs) and psychotic disorder were measured by a semistructured interview. After adjusting for sex, age, body mass index, ethnicity, social class, past psychological and behavioral problems, and maternal postpartum depression, participants in the top third of IL-6 values compared with the bottom third at age 9 years were more likely to be depressed (CIS-R) at age 18 years (adjusted odds ratio [OR], 1.55; 95% CI, 1.13-2.14). Results using the MFQ were similar. Risks of PEs and of psychotic disorder at age 18 years were also increased with higher IL-6 levels at baseline (adjusted OR, 1.81; 95% CI, 1.01-3.28; and adjusted OR, 2.40; 95% CI, 0.88-6.22, respectively). Higher IL-6 levels in childhood were associated with subsequent risks of depression and PEs in a dose-dependent manner. Higher levels of the systemic inflammatory marker IL-6 in childhood are associated with an increased risk of developing depression and psychosis in young adulthood. Inflammatory pathways may provide important new intervention and prevention targets for these disorders. Inflammation might explain the high comorbidity between heart disease, diabetes mellitus, depression, and schizophrenia.
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                Author and article information

                Contributors
                Journal
                Brain Behav Immun Health
                Brain Behav Immun Health
                Brain, Behavior, & Immunity - Health
                Elsevier
                2666-3546
                29 September 2021
                December 2021
                29 September 2021
                : 18
                : 100359
                Affiliations
                [1]Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                Article
                S2666-3546(21)00162-9 100359
                10.1016/j.bbih.2021.100359
                8521124
                34704078
                f4826561-322d-4a21-a4e8-2dd5879b780a
                © 2021 The Author

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 21 May 2021
                : 22 September 2021
                : 27 September 2021
                Categories
                Full Length Article

                postpartum psychosis,immune system,inflammation,biomarkers,perinatal period

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