POSTPARTUM PSYCHOSIS
INTRODUCTION
- most severe forms of Perinatal mood disorder
- labelled post-partum (or puerperal) psychosis
- used to refer to new onset, although not necessarily the first episode, of severe affective psychosis
in the immediate puerperium.
- 90% of cases - within 2 weeks of delivery
- core concept is the acute post-partum onset of mania or affective psychosis
- Usually associated suggest the diagnosis of bipolar disorder, unipolar psychotic depression or a
family history of affective disorder
- the continuation of a more chronic psychosis, such as schizophrenia, would not be appropriately
labelled as post-partum psychosis.
- symptomatology and prognosis of PP resemble those of an affective disorder, rather than those of
schizophrenia. Symptoms are those of a severe mood disorder often accompanied by psychotic
symptoms such as delusions and hallucination.
- polymorphic or cycloid psychosis’
EPIDEMIOLOGY
- severe psychiatric condition which affects 1-2 of every 1000 mothers shortly after childbirth.
- specific link between childbirth and the triggering of mania or an affective psychosis is well
established.
- even if admitted for another psychiatric disorder, such as major depression, a first admission
within the first month after childbirth increases four times the likelihood of developing bipolar
disorder within 15 years, compared to any first psychiatric admission outside the childbearing
period.
- In more than 50% of women experiencing PP, it is their first psychiatric episode and therefore
difficult to predict
RISK FACTORS
- Women with a history of bipolar disorder have a 1 in 5 chance of PP for each delivery
- a previous episode of PP confers an even higher risk in excess of 1 in 2
- A family history of PP has also been identified as doubling the risk of PP in women with a
personal history of bipolar disorder
- Among patients who develop PP immediately after childbirth, 72%–88% have bipolar illness or
schizoaffective disorder, wheras only 12% have schizophrenia.
- Puerperal hormone shifts, 17 obstetrical complications, 18,19 sleep deprivation, 20 and increased
environmental stress are possible contributing factors to the onset of illness.
- Patients who stop their mood stabilizer treatment, specifically lithium.
- The mothers who cease antimanic treatment suddenly have an added risk for relapse
- Sleep loss, such environmental stressors as marital discord, and the precipitous drop in hormone
levels that occurs shortly after childbirth are other factors linked to PP
- Primiparity, socioeconomic status, and ethnicity are less compelling risk factors
CLINICAL PRESENTATION
- within the first 2–4 weeks after delivery
- Escalates to florid psychosis within days postpartum and often results in presentation for
treatment within 3 weeks postpartum.
- onset of PP is rapid. 8 As early as 2–3 days after childbirth, the patient develops paranoid,
grandiose, or bizarre delusions, mood swings, confused thinking, and grossly disorganized
behavior that represent a dramatic change from her previous functioning.
INTRODUCTION
- most severe forms of Perinatal mood disorder
- labelled post-partum (or puerperal) psychosis
- used to refer to new onset, although not necessarily the first episode, of severe affective psychosis
in the immediate puerperium.
- 90% of cases - within 2 weeks of delivery
- core concept is the acute post-partum onset of mania or affective psychosis
- Usually associated suggest the diagnosis of bipolar disorder, unipolar psychotic depression or a
family history of affective disorder
- the continuation of a more chronic psychosis, such as schizophrenia, would not be appropriately
labelled as post-partum psychosis.
- symptomatology and prognosis of PP resemble those of an affective disorder, rather than those of
schizophrenia. Symptoms are those of a severe mood disorder often accompanied by psychotic
symptoms such as delusions and hallucination.
- polymorphic or cycloid psychosis’
EPIDEMIOLOGY
- severe psychiatric condition which affects 1-2 of every 1000 mothers shortly after childbirth.
- specific link between childbirth and the triggering of mania or an affective psychosis is well
established.
- even if admitted for another psychiatric disorder, such as major depression, a first admission
within the first month after childbirth increases four times the likelihood of developing bipolar
disorder within 15 years, compared to any first psychiatric admission outside the childbearing
period.
- In more than 50% of women experiencing PP, it is their first psychiatric episode and therefore
difficult to predict
RISK FACTORS
- Women with a history of bipolar disorder have a 1 in 5 chance of PP for each delivery
- a previous episode of PP confers an even higher risk in excess of 1 in 2
- A family history of PP has also been identified as doubling the risk of PP in women with a
personal history of bipolar disorder
- Among patients who develop PP immediately after childbirth, 72%–88% have bipolar illness or
schizoaffective disorder, wheras only 12% have schizophrenia.
- Puerperal hormone shifts, 17 obstetrical complications, 18,19 sleep deprivation, 20 and increased
environmental stress are possible contributing factors to the onset of illness.
- Patients who stop their mood stabilizer treatment, specifically lithium.
- The mothers who cease antimanic treatment suddenly have an added risk for relapse
- Sleep loss, such environmental stressors as marital discord, and the precipitous drop in hormone
levels that occurs shortly after childbirth are other factors linked to PP
- Primiparity, socioeconomic status, and ethnicity are less compelling risk factors
CLINICAL PRESENTATION
- within the first 2–4 weeks after delivery
- Escalates to florid psychosis within days postpartum and often results in presentation for
treatment within 3 weeks postpartum.
- onset of PP is rapid. 8 As early as 2–3 days after childbirth, the patient develops paranoid,
grandiose, or bizarre delusions, mood swings, confused thinking, and grossly disorganized
behavior that represent a dramatic change from her previous functioning.
