Postpartum psychosis : Meaning, Causes,Diagnosis, Symptoms and Treatments

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INTRODUCTION

Postpartum psychosis is a serious disorder that can cause negative consequences for the mother, infant, and entire family. Childbirth is known to be a significant physical, emotional and social stressor in the life of a woman.

Days to weeks after a woman has giving birth, she might experience some mental disturbances like mood swings or a mild depression also known as baby blues. However for some women it is usually more severe.

Changes in The mood and Emotions of a new mother are the common and expected. However, These changes differ as some women experience more ups and downs during the post partum period.

Many factors play a role in postpartum mental health. The most severe among all of these mental changes is the condition known as postpartum psychosis or puerperal psychosis.

WHAT IS POSTPARTUM PSYCHOSIS

Post partum simply means after childbirth.

Postpartum psychosis is an intense mental illness characterized by an exceptional difficulty in responding emotionally to a newborn baby — it can even include thoughts of harming the child.

In fact, Dr. Ladd qualifies postpartum psychosis as a “psychiatric emergency,” because of the potential for harm to the baby or the new mother.

PREVALENCE OF POSTPARTUM PSYCHOSIS

The estimation of the global prevalence on post partum psychosis is

With an estimated global prevalence of 0.089 to 2.6 per 1000 births, post partum psychosis classifies as an illness with a low incidence rate, though it carries the potential for a severe medical and social consequences, including the risk of suicide and filicide

RISK FACTORS

Post partum psychosis has a lot of origin.  

While some women can have postpartum psychosis with no risk factors, there are some factors known to increase a woman’s risk for the condition. They include:

  • History of bipolar disorder
  • History of postpartum psychosis in a previous pregnancy
  • History of schizoaffective disorder or schizophrenia
  • Family history of postpartum psychosis or bipolar disorder
  • First pregnancy
  • Discontinuation of psychiatric medications for pregnancy

The exact causes of postpartum psychosis aren’t known. Doctors know that all women in the postpartum period are experiencing fluctuating hormone levels. However, some seem to be more sensitive to the mental health effects of changes in hormones like estrogen, progesterone, and/or thyroid hormones. Many other aspects of health can influence causes of postpartum psychosis, including genetics, culture, and environmental and biologic factors. Sleep deprivation may also play a role.

DIAGNOSIS

How do doctors diagnose postpartum psychosis?

A doctor will start by asking you about your symptoms and how long you’ve been experiencing them. They will also ask about your past medical history, including if you’ve had any history of:

  • Depression
  • Bipolar disorder
  • Anxiety
  • Other mental illness 
  • Family mental health history
  • Thoughts of suicide, or harming your baby
  • Substance abuse

It’s important to be as honest and open as possible with your doctor so you can get the help you need. 

A doctor will try to rule out other conditions and factors that could be causing behavior changes, such as thyroid hormones or postpartum infection. Blood testing for thyroid hormone levels, white blood cell counts, and other relevant information can help. 

A doctor may ask a woman to complete a depression screening tool. These questions are designed to help doctors identify women who are experiencing postpartum depression and/or psychosis.

SYMPTOMS

  • Delusions or strange beliefs
  • Hallucinations
  • Feeling very irritated
  • Hyper activity
  • Decreased need for sleep or inability to sleep
  • Paranoia and suspiciousness
  • Rapid mood swing
  • Difficulty in communicating at times

TREATMENT

Postpartum psychosis is a medical emergency. A person should call the hospital and seek treatment at an emergency room, or have someone take them to an emergency room or crisis center.  Your doctor may decide that treating you in hospital is the best way to get the help you need.

If it’s possible, you should be admitted to a mother and baby unit (MBU), where you can stay with your baby while getting treatment. 

Often, a woman will receive treatment at an inpatient center for at least a few days until her mood is stabilized and she is no longer at risk for harming herself or her baby.

Treatments during the psychotic episode include medications to reduce depression, stabilize moods, and reduce psychosis. Examples include:

  • Antipsychotics: These medications reduce the incidence of hallucinations. Examples include risperidone (Risperdal), olanzapine (Zyprexa), ziprasidone (Geodon), and aripiprazole (Abilify).
  • Mood stabilizers: These medications reduce manic episodes. Examples include lithium (Lithobid), carbamazepine (Tegretol), lamotrigine (Lamictal), and divalproex sodium (Depakote).
  • No single ideal combination of medications exists. Each woman is different and may respond better to antidepressants or antianxiety medicines instead of or in combination with a drug from the above categories.
  • If a woman doesn’t respond well to medicines or needs further treatment, electroconvulsive shock therapy (ECT) is often very effective. This therapy involves delivering a controlled amount of electromagnetic stimulation to your brain.

The effect creates a storm or seizure-like activity in the brain that helps to “reset” the imbalances that caused a psychotic episode. Doctors have safely used ECT for years to treat major depression and bipolar disorder.

  • Lithium is commonly used in the treatment of PP; however, the evidence to support this treatment option is scarce. In the few studies conducted to date (Lichtenberg et al. 1988; Silbermann et al. 1975; Targum et al. 1979), lithium treatment for PP is generally supported. The effectiveness of lithium in the treatment of bipolar disorder is well documented and it has been suggested that lithium is equally effective with postpartum women as it is with non- postpartum women (Abou-Saleh and Coppen 1983). Fur- ther comparative investigations are needed that examine Safety of medication during pregnancy and breastfeeding

An important consideration is the reproductive safety of medication in pregnancy and breastfeeding. While beyond the scope of this review, there is clearly a need to conduct a risk benefit analysis with each individual woman.

Although some medications are associated with particular problems, there are no universal recommendations that can be made about whether to continue or stop and the decision must ultimately lie with the woman and her family.

Moreover, women with bipolar disorder need to be informed early in their illness about the risks in childbirth and the reproductive safety of medication and family planning should be discussed when drugs are prescribed.

Psychological therapy

As you move forward with your recovery, your GP may refer you to a therapist for cognitive behavioral therapy (CBT). CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.

Self-care for postpartum psychosis

If you are experiencing postpartum psychosis, the most important thing to do is get help. Speak to a health professional if you feel able, such as your doctor or a psychiatrist.

If you don’t feel able to speak to a health professional, you could talk to someone who you trust about how you’re feeling, and ask for their support in getting help. Once you’re receiving professional help, there are things you can also do to look after yourself while you recover:

Join a peer support group

You might feel really alone or as if nobody understands, but talking to other people can help. Peer support is a way to share your feelings and experiences with other people who’ve had similar experiences.

Action on Postpartum Psychosis runs a peer support network for women who have experienced postpartum psychosis. Or you could try an online peer support group, like Mind’s supportive community Elefriends.

Recognize your triggers

Try keeping a diary of your moods and what’s going on in your life. This might help you recognize patterns or notice what affects your mental health. It can also help you become aware of the sort of experiences or feelings that might make you feel worse. This gives you the chance in future to notice what’s going on before you become more unwell, and ask for help.

Contact specialist organizations

Action on Postpartum Psychosis has a guide to recovering from postpartum psychosis. This includes lots of tips and ideas about how to cope in the days and months after being diagnosed.

Planning another pregnancy

If you have experienced postpartum psychosis before, you may worry about becoming pregnant again. 

Experiencing postpartum psychosis does mean you are more likely to develop it again with future pregnancies. But with the right support, you can plan ahead in case it does happen again.

So if you want to have another baby, or if you find out that you’re pregnant, you should talk to your doctor and make a plan as soon as possible.

Your doctor can also refer you to a perinatal psychiatrist. This is a specialist doctor who can support you if you are pregnant or recently gave birth, and have experience of mental health problems.

Action on Postpartum Psychosis (APP) has a series of guides about postpartum psychosis. This includes a guide to planning pregnancy if you are at high risk of developing postpartum psychosis.

Medication and breastfeeding

If you have a postpartum psychosis, you will probably need treatment with an antipsychotic medication, a mood stabilizer or both. You can breastfeed whilst taking some medications.Discuss the risks and benefits of doing this with your psychiatrist. 

You may find that you can’t breastfeed. You may be too unwell, or may have to be in hospital without your baby. You may need a medication, which is not safe in breastfeeding. You might feel guilty about being unable to breastfeed – but it’s not your fault, just as the psychosis is not your fault. It’s just important that you have the treatment you need so that you can get better and get on with looking after and enjoying your baby.

Links for support

You may find the following links useful:

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