Puerperal Psychosis: Causes, Symptoms and Treatment

Puerperal psychosis is a serious or life-threatening mental condition which affects the personality of the woman during puerperium (mostly primipara). Its onset is rapid and usually occurs within the first few days after   delivery.  

The   symptoms characterized by this mental illness are similar with those   of   depressive psychosis, manic illness and schizophrenia in some cases.

The affected mother shows bizarre behavior, loses touch with reality and may suffer from hallucinations. The onset of these symptoms may be heralded by a time of acute restlessness and inability to sleep. Frequently the mother may deny that her baby belongs to her and in rare cases she may harm the baby.

puerperal pyschosis

How common is puerperal psychosis?

Psychiatric disorders can occur during pregnancy, labour or puerperium. Puerperal psychosis is not common (about 1 or 2 in every 1000 births) but tends to be more common in primigravida. 

Most women experience a phase of depression called “maternity blues” during puerperal period, in which its poor treatment can result in a fatal mental state, known as puerperal psychosis or postpartum psychosis

Causes of postpartum psychosis

The causes of puerperal psychosis are complex and multi-layered. These include genetic factors, environmental factors (social isolation, brain injury/ trauma, and stress), lifestyle (drug or alcohol abuse) and psychological factors (mood disorders, anxiety disorders, schizophrenia or bipolar disorder and personality traits).

The cause of puerperal psychosis is likely involves a combination of these factors above. It is believed that some people may be more likely to develop this condition if they are living in an area with high levels of pollution or if they are living in an area with a history of mental illness. However, getting treatment as soon as possible to helps prevent further damage to the individual and their family.

Risk factors of puerperal psychosis

  • Normal pregnancy and labour trigger certain degree of emotional strains on a woman’ s mental health, which failure to adapt or adjust may set in a psychiatric disorder
  • Traumatic labour and delivery
  • Previous history of mental illness
  • Hereditary
  • Mal-adjusted personality suffered much from gross disharmony in marriage, which can cause mental illness
  • Infection (e.g. septicemia or bacteremia) can trigger  confusion

Signs and symptoms of puerperal psychosis

  • Persistent or prolonged insomnia (early signs)
  • Depressed and weepy state
  • Unusual sadness, irritability or anxiety
  • Elatedness and talkative, often becoming aggressive or violent
  • A need for excessive admiration and attention
  • Confusion or delusional state
  • A preoccupation with fantasies of power or success.
  •  Excessive concern with one’s own appearance, often to the point of obsession
  • Hallucinating (e.g. visual and auditory)
  • Feeling guilty or self-blame
  • Excessive self-doubt and hating of husband, baby or the midwife
  • Suicidal tendencies to either self or baby
  • Mal-handling or odd way of handling baby
  • Unwarranted suspicion and persecutory (paranoid)
  • Refusal of meal or taking baths
  • Disorientation and liability (e.g. sudden laughter or depression)

How to treat postpartum psychosis

The patient must be treated promptly by admission to a psychiatry unit under the care of a consultant. In most cases, the baby will be allowed to accompany his mother to hospital and this should be encouraged if there is availability of adequate vital and skilled psychiatric nursing care.

This involves use of medication (antipsychotic medications and mood stabilizers), psychotherapy, lifestyle changes and electroconvulsive therapy

  • Lifestyle changes can help people improve their mental health by decreasing stress levels and improving their social support network as well as learn coping mechanisms.
  • Electroconvulsive therapy can help to treat the patient’s psychosis by inducing a seizure.
  • Antipsychotic medications and mood stabilizers can help treat symptoms such as hallucinations, delusions, and depression. The medications often used include chlorpromazine (Largactil, 50mg), Librium 10-20mg, and Barbiturate (e.g. phenobarbitone 30-60mg).
  • Psychotherapy can help the patient learn how to manage their symptoms and improve their overall mental health. The psychotherapeutic tips include:
  • Reassure her and boost her confidence
  • Recognize early signs and provide appropriate care.
  • Help her overcome fear by clearing false information
  • Treat all women in puerperium with good care and love

The prognosis of postpartum psychosis

With prompt treatment, the prognosis is good. However,  unfortunately, it is likely that further episodes of the illness will occur throughout the woman’s life around  there  is  a  high  risk  of  recurrence  in  subsequent pregnancies.

Summary

Puerperal psychosis is an illness that affects young adults in their late teens and early twenties after delivery. It is a mental disorder that causes elevated mood, energy and activity levels, delusions, hallucinations, irrational thoughts and other psychiatric symptoms.  It is also known as juvenile schizophrenia. Symptoms of puerperal psychosis can last for months or even years.

There is no one cause of puerperal psychosis. It is believed to be caused by a combination of genetic and environmental factors. Some people are more likely to develop puerperal psychosis than others.

The prognosis for puerperal psychosis is very uncertain and can vary greatly depending on the individual.  Some people may have a milder form of the disorder and may not require any treatment, while others may have a more severe form and may require long-term treatment. There is no known cure for puerperal psychosis, but it can be managed with medication and therapy.

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