Related Subjects:
|Psychiatric Emergencies
|Depression
|Mania
|Schizophrenia
|Suicide
|Acute Psychosis
|Delusions
|General Anxiety Disorder
|Obsessive-Compulsive disorder
|Wernicke Korsakoff Syndrome
|Medically Unexplained symptoms
|Postpartum/Postnatal Depression
|Postpartum / Postnatal Psychosis
Treatment: Requires hospitalisation. Anti-psychotics and/or Antidepressant
Background
- Postpartum psychosis is a rare but serious psychiatric condition, with an incidence of 1 in 500 to 800 deliveries.
- It typically begins between 2 to 7 days after delivery, with symptoms peaking around 2 weeks postpartum.
- Distinct from postpartum depression and anxiety. Patient has psychotic features
- Postpartum psychosis is considered a medical emergency because of its rapid onset and the potential severity of symptoms.
Diagnosis
- The diagnosis is based on the presence of psychotic symptoms, including:
- Delusions: Fixed, false beliefs, often involving the infant (e.g., thoughts of harm or delusional beliefs about the baby's health or identity).
- Hallucinations: Sensory perceptions without external stimuli, such as hearing voices instructing the mother to harm herself or the infant.
- Cognitive Impairment: Disorganized thinking, poor concentration, and confusion.
- Mood Instability: Rapid and extreme mood swings, which may include mania, depression, or a combination of both.
- These symptoms are often preceded by severe insomnia and restlessness, which may serve as early warning signs.
CLinical
- The mother may be unaware she is ill (Due to psychosis).
- Severe mood disturbance (Manic and/or Depressive)
- Thought disturbance (either processing or bizarre thoughts)
- Insomnia
- Inappropriate responses to the baby.
- Can be LIFE THREATENING for both mum & bub if undiagnosed and unmanaged
Risk factors for postpartum psychosis include
- A personal or family history of psychosis or bipolar disorder.
- Previous episodes of postpartum psychosis, which increase the risk of recurrence.
- Primiparity (first-time motherhood).
- Marital discord or lack of social support.
- Discontinuation of psychotropic medications, particularly in women with bipolar disorder.
Management
- Immediate hospitalization is required to ensure the safety of both the mother and infant. The risk of suicide increases dramatically, with a 70-fold higher likelihood during the first postpartum year in women with postpartum psychosis.
- Homicidal thoughts, particularly directed toward the infant, are more common in postpartum psychosis than in other postpartum mood disorders.
- Pharmacological treatment includes:
- Antipsychotic medications to control psychotic symptoms.
- Mood stabilizers, such as lithium or anticonvulsants, particularly in women with bipolar disorder.
- Short-term use of sedatives to manage severe insomnia or agitation.
- In severe cases, electroconvulsive therapy (ECT) may be considered, especially if there is a risk of harm or if pharmacotherapy proves ineffective.
- Women with early onset of psychosis (within the first month postpartum) may have more severe hallucinations and delusions but generally respond better to early intervention and treatment.
- In women with a history of schizophrenia, the risk of recurrence of psychotic symptoms postpartum is as high as 30% to 50%, necessitating close monitoring and an individualized treatment plan.
- After recovery, long-term psychiatric care may be required to prevent future episodes and to support the mother’s mental health, particularly in women with pre-existing psychiatric disorders.