INTRODUCTION:

Postpartum psychosis is rare psychotic disorder usually begins 2 or 3 days after delivery. It is considered as one of the most dangerous forms of postpartum stress disorders; however, so many psychiatrists encourage family members to take active steps towards distressing a new mother's environment.

DEFINITION:

The term postpartum psychosis describes the range of physical, emotional, and behavioral changes that many new mothers experience following child birth in which woman loses touch with reality. Psychosis may be depression or manic episode

PREVALENCE:

· One or two per every 1,000 births.

· Woman with a personal history of psychosis, bipolar disorder or schizophrenia have an increased risk of developing postpartum psychosis.

· Woman who have a family history of psychosis, bipolar disorder or schizophrenia have a greater chance of developing the disorder.

· 20% and 50% risk with previous history.

· Postpartum psychosis has a 5% suicide rate and a 4% infanticide rate.

· 80% cases symptoms occurs within 14 days.

· Recurrence rate is 33% to 51%.

CAUSES:

· Postpartum psychosis is triggered by dramatic drop in estrogen, progesterone and prolactin

· Lack of social and emotional support

· Low sense of self-esteem due to a woman’s postpartum appearance

· Feeling inadequate as a mother; isolated and alone

· Financial problems, major life change such as moving or starting a new job.

SYMPTOMS:

Onset may be at anytime within the first three months after giving birth, woman who have postpartum psychosis usually develop symptoms within the first two to three weeks after delivery.

Signs of postpartum psychosis include:

· Hallucinations

· Delusions

· Illogical thoughts

· Insomnia

· Refuse to eat

· Extreme feelings of anxiety and agitation

· Periods of delirium or mania

· Suicidal or homicidal thoughts (towards baby)

· Perplexity.

· Confusion.

· Emotions like extreme fear and ecstasy.

· Catatonia or rapid changes of mental state with transient delusional ideas.

Some mothers may have typical manic symptoms with highly disorganized speech and extreme excitement. Some switch from mania to depression (or vice versa) within the same episode.

DIAGNOSIS:

· History from the mother and relatives.

· Complete blood chemistry, thyroid function and antithyroidantibody tests, calcium, vitamin B₁₂, and folate level.

TREATMENT:

With modern therapy features resolve within a few weeks.

1. Antipsychotic drugs to treat over activity and delusions

2. Electro convulsive therapy

3. Mood stabilizers Ex. Lithium to treat mood excitement.

4. Close observation by the relative and care takers.

5. Psychological counseling and supportive group therapy.

Dealing with Postpartum Emotions

Listen: Husband has to listen, provide tender support and help the wife who is struggling with postpartum emotions.

Help her on a simple schedule: Mother has to be supported into a simple routine with few easy tasks. A little bit of structure goes a long way.

Encourage the mother to get medical help: Evaluation of the mood changes and early treatment is very essential to prevent the compilations.

Is there a chance of relapse in Post partum psychosis?

A small minority follow a relapsing pattern, usually related to the menstrual cycle.

Mothers who suffer a puerperal episode are liable to other manic depressive or acute polymorphic episodes, after other children are born, some during pregnancy or after an abortion, and some unrelated to childbearing.

Puerperal recurrences occur after at least 20% of subsequent deliveries.

COMPLICATIONS:

1. Mood changes

2. Hallucinations.

3. Mood alterations.

PREVENTION:

· Emotional support for the mother throughout the pregnancy and post partum preventing the sleep loss near delivery may avert the episode pf postpartum psychosis.

· Careful and complete investigation woman with a postpartum mood disorder to determine thepresence of psychosis and prevent infanticide.

· Assess the mental status for the presence of bizarre delusions,tactile or olfactory hallucinations and cognitive impairmentmay detect an emerging psychosis.

CONCLUSION:

Postpartum psychosis is a psychiatric emergency. Fortunately there is good news – most women with postpartum psychosis respond well to treatment with medication and to intensive nursing. Full recovery usually occurs but future relapses - both after having a baby and at other times - are possible. Inpatient psychiatrictreatment is essential to ensure the safety of mother and baby.

REFERENCES:

1. Meltzer E.S. and Kumar (1985),' Puerperal mental illness, clinical features and classification', British Journal of psychiatry.

2. Lara L Miller (2004),'Postpartum mood disorders', Springer Netherlands.

3. M. Twomey, J.D, Shoshana Bennett (2009),'Understanding Postpartum Psychosis: A Temporary Madness’, Praeger Publishers, Westport.

4. http://www.pregnancy-info.net/postpartum_psychosis.html

Received on 20.07.2011 Modified on 19.10.2011

Asian J. Nur. Edu. and Research 1(3): July-Sept. 2011; Page 96-97