One in 1000 women who have a baby suffers a psychotic break shortly after delivery.
Symptoms of psychosis rarely appear in women in the immediate aftermath of childbirth. Although psychiatric manuals do not list puerperal psychosis as a specific disorder, many professionals use this concept to refer to such situations.
In this article we will analyze the symptoms and main causes of puerperal psychosis, as well as other of its basic characteristics. We will also briefly review the treatment options currently available to manage this problem.
What is puerperal psychosis?
Puerperal or postpartum psychosis is a type of psychotic disorder that appears in women who have just had a baby, usually within two weeks of delivery. It is characterized by typical symptoms of psychosis such as hallucinations, delusions, disorganized thinking, behavioral disinhibition, and catatonia.
In psychotic disorders there is a loss of contact with reality that can manifest itself in different areas and has a variable severity. It is believed that there is a strong genetic influence that determines the development of psychosis symptoms.
This form of psychosis was described by the German obstetrician Friedrich Benjamin Osiander in 1797. In the past, puerperal psychosis was attributed to infections, thyroid disorders, or eclampsia, a seizure disorder of pregnancy; Although these hypotheses have been ruled out (except thyroid), the causes remain unclear.
It is a relatively rare condition, affecting 1 in every 1,000 women who give birth. In comparison, postpartum depression, a subtype of major depressive disorder, occurs in approximately 15% of mothers. Although psychotic symptoms can appear in the setting of postpartum depression, they are different disorders.
The DSM manuals do not include the diagnosis of puerperal psychosis; Using these guidelines, these cases should be classified as “Unspecified Psychotic Disorders”. In the ICD-10 we find the category “Mental and behavioral disorders in the puerperium”, which also includes postpartum depression.
Common symptoms and signs
The reported symptoms and observable signs of puerperal psychosis vary greatly depending on the specific case, and even throughout the course of the disorder in the same person. Opposite symptoms, such as euphoria and a depressed state, sometimes occur together.
The most common initial signs of postpartum psychosis include feelings of euphoria, reduced amount of sleep, mental confusion, and verbiage.
In addition to being classifiable as a psychotic-like picture similar in nature to schizophrenia or schizoaffective disorder, the usual symptoms of puerperal psychosis sometimes also resemble those of mania and depression, the main alterations in the state of cheer up.
- Delusions and other strange beliefs
- Hallucinations, especially auditory type
- Paranoia and suspicion
- Irritability and emotional instability
- Low mood, even depressed
- Mania: feeling of euphoria, increased energy and psychological agitation
- Racing thinking and severe confusion
- Communication difficulties
- Motor hyperactivity and behavioral disinhibition
- Decreased need or ability to sleep
- Lack of recognition of alterations
- Increased risk of suicide and infanticide
Causes and risk factors
Research reveals that puerperal psychosis is associated with schizophrenia, bipolar disorder, and schizoaffective ; about a third of women with these disorders experience severe psychotic episodes after childbirth. In addition, people with postpartum psychosis have a 30% chance of having another episode in subsequent pregnancies.
It is believed that there is a genetic component in this disorder, since the fact that a close relative has been diagnosed with puerperal psychosis increases the risk of developing it by approximately 3%. Family history of depression in pregnancy or postpartum, psychotic-affective disorders, and thyroid dysfunction are also risk factors.
However, half of the women with puerperal psychosis do not have any risk factor; A hypothesis that could explain this would be the one that associates this disorder with the hormonal changes and the sleep cycle that occur after childbirth. New mothers seem to be more likely to develop this type of psychosis.
Treatment of postpartum psychosis
When a case of postpartum psychosis is detected, the most common is that the hospital stay is lengthened, or the mother is hospitalized again. In general, the management of this disorder is carried out through pharmacotherapy, although there are emergency psychological intervention programs for psychosis that can be very useful as a complement.
Among the drugs used to treat this disorder, two categories stand out: antipsychotics and mood stabilizers , psychoactive drugs of reference in bipolar disorder. Antidepressants can also be helpful in managing symptoms such as depressed mood, irritability, trouble sleeping, and cognitive problems.
Cases resistant to drug treatment that are also serious, such as those with a manifest risk of suicide, are sometimes treated with electroconvulsive therapy.
Most people with this disorder make a full recovery after six months to a year, while the severity of symptoms usually decreases clearly before three months after delivery. The risk of suicide remains high during the recovery period.
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