Postpartum Psychosis

Postpartum psychosis is a mal-adaption to the stress & conflicts of postpartum period

AKA Puerperal Psychosis

This is the most serious of the postpartum "blues"/depression

Risk of suicide is significant

Risk of infanticide is as high as 4% if disorder unrecognized and/or untreated

As with postpartum depression, women who experience postpartum psychosis had a favorable attitude toward their pregnancy:

Elated and excited about the pregnancy

Tolerated pregnancy well with minimal discomfort

Eager to breastfeed, generally follow through with breastfeeding and are usually quite successful with it

Again, some literature sources indicate it may be related to the sudden decrease (change) in hormone levels-- estrogen, progesterone and cortisol--during the postpartum period

Excitement and elation are evident during the pregnancy when placental hormonal levels high

Following delivery and the sudden decrease in hormonal levels, postpartum depression appears

Controversy still continues regarding high prolactin levels in the breastfeeding woman and the association for an increased risk of postpartum depression or postpartum psychosis 

Prolactin inhibits the release of progesterone

Yet again, there are some predictors of postpartum psychosis

Obsessive personality

Poor relationship with parents and/or partner

History of manic depressive behaviors (Bipolar Disorder)

20-25% will have a relapse during the postpartum period

History of previous postpartum psychosis

Multiple life stressors

Poor coping skills

Single, separated, divorced

Significant loss in the last year

Previous miscarriage or stillbirth

Substance use

 

Incidence:

1-2 cases/1000 births (0.1-0.2%)

Occurrence:

Usually within the 1st-3rd months postpartum

 

Symptoms include those previously noted plus:

Hallucinations

Auditory hallucinations may instruct the mother to harm or kill herself or her infant

Delusions

May believe her infant is Satan or God

May believe her infant has special powers 

May believe her infant is defective or is dying

Phobias

Extreme agitation and labile emotions

Sleeplessness

 

Treatment Interventions/Options:

Psychiatric care

Psychotherapy--individual, group or both

Counseling

Hospitalization

Electroconvuslive therapy

Medications

Serotonin-reuptake inhibitors (SSRIs)

See previous section for additional information

SSRIs are used mainly to treat manic phase

Common examples include:  Lithium, Depakote, Tegretol

Antipsychoctics

Antipsychotic medications, like the other medications mentioned, help restore the chemical balance in the brain

They reduce or eliminate the psychotic symptoms--hallucinations, delusions and/or thought disorders--generally allowing the individual to function more effectively and appropriately

They usually take days to weeks for their full effect to be realized

Common examples include:  Thorazine, Zyprexa, Respirdal, Seroquel

 

Postpartum psychosis is a very serious condition

The woman is a danger to both herself and her infant

There is the risk of suicide and/or homicide

If unrecognized and/or untreated, postpartum psychosis has a high likelihood of recurrence

Up to 70% of women who have had one (1) experience with postpartum psychosis will experience another with subsequent pregnancies and births

 

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