| Postpartum psychosis | |
|---|---|
| Other names | Puerperal psychosis, peripartum psychosis |
 | |
| Rate and timing of onset of psychoses among Swedish first-time mothers | |
| Specialty | Obstetrics, psychiatry |
| Symptoms | Hallucinations, delusions, mood swings, confusion, restlessness, personality changes [1] |
| Complications | Suicide, infanticide [2] |
| Usual onset | Within 2 weeks of delivery [3] |
| Duration | 1 to 12 months [2] |
| Causes | Unclear [1] |
| Risk factors | First pregnancies, older age, loss of sleep, personal or family history of the condition or bipolar disorder [4] [3] |
| Diagnostic method | Based on symptoms after ruling out other potential causes [2] |
| Differential diagnosis | Normal adjustment after birth, postpartum depression, post partum bleeding, endometritis, drug intoxication, drug withdrawal, autoimmune thyroiditis, autoimmune encephalitis, postpartum obsessive-compulsive disorder [3] [4] |
| Treatment | Anti-psychotics, lithium, benzodiazepines, electroconvulsive therapy (ECT) [3] [4] |
| Frequency | 1 to 2 per 1000 childbirths [3] [4] |
Postpartum psychosis (PPP) involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks. [3] [4] Symptoms may include seeing or smelling things that are not there ( hallucinations), thoughts that are unlikely to be true ( delusions), abnormally elevated mood ( mania), depression, anxiety, or confusion. [1] Other symptoms may include disorganized thoughts, difficulty sleeping, and variable mood and consciousness. [3] [4] There is generally little understanding of the severity of the condition by the person themselves. [4] Over half of those affected are later diagnosed with bipolar. [4]
The cause is unknown, though may relate to hormone changes, immune system problems, and genetics. [1] [4] [3] Risk factors include first pregnancies, older age, loss of sleep, and a personal or family history of PPP or bipolar disorder. [4] [3] Life stress does not appear to play a role, nor is evidence clear around complications of pregnancy. [2] There are no screening or assessment tools for diagnosis; [3] which is made based on the presenting symptoms, guided by criteria in the DSM-V after ruling out other potential causes. [2] In the Diagnostic and Statistical Manual of Mental Disorders, Volume V (DSM-V TR) it is under brief psychotic disorder with the specifier "peripartum onset", rather then as a separate entity. [5] [2]
It is considered a psychiatric emergency requiring urgent hospitalization. [3] Treatment may include medications such as lithium, benzodiazepines, and antipsychotics, as well as the procedure electroconvulsive therapy (ECT). [3] [4] In cases where a women has previously been effected lithium may be started preventatively immediately after delivery. [4] Psychotic symptoms, particularly those that include delusions of misidentification, cause safety concerns for the baby and mother; [6] with the condition resulting in the child's death in 4% of cases and a risk of suicide by the mother. [4] Divorce occurs in up to 20%. [2]
Postpartum psychosis occurs in 1 to 2 per 1000 childbirths. [3] [4] Rates appear similar in different cultures and social classes. [2] More frequently, it occurs in the context of known or new-onset bipolar, known as postpartum bipolar disorder. [2] The condition has been described since 400 BC by Hippocrates. [3]
References
- ^ a b c d "Postpartum psychosis". 11 February 2021. Archived from the original on 7 March 2021. Retrieved 6 January 2024.
- ^ a b c d e f g h i Hutner LA, Catapano LA, Nagle-Yang SM, Williams KE, Osborne LM, eds. (2021). Textbook of Women's Reproductive Mental Health. Washington, D.C.: American Psychiatric Association Publishing. ISBN 978-1-61537-386-4. OCLC 1289371393. Archived from the original on 2024-01-11. Retrieved 2024-01-06.
- ^ a b c d e f g h i j k l m n Osborne LM (September 2018). "Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers". Obstetrics and Gynecology Clinics of North America. 45 (3): 455–468. doi: 10.1016/j.ogc.2018.04.005. PMC 6174883. PMID 30092921.
- ^ a b c d e f g h i j k l m n Rodriguez-Cabezas L, Clark C (September 2018). "Psychiatric Emergencies in Pregnancy and Postpartum". Clinical Obstetrics and Gynecology. 61 (3): 615–627. doi: 10.1097/GRF.0000000000000377. PMC 6143388. PMID 29794819.
- ^ Diagnostic and statistical manual of mental disorders: DSM-5-TR™ (Fifth, text revision ed.). Washington, DC: American Psychiatric Association Publishing. 2022. p. 108. ISBN 9780890425763.
- ^ Lewis G, Blake L, Seneviratne G (September 2022). "Delusional Misidentification Syndromes in Postpartum Psychosis: A Systematic Review". Psychopathology. 56 (4): 285–294. doi: 10.1159/000526129. PMID 36116435. S2CID 252341410.