Puerperal Psychosis Information For Patients, Families and Carers
Postnatal illness is a term which covers three degrees of mental illness which can occur after the birth of a baby. The mildest and shortest lived of these is the 'baby blues' and the most severe form is puerperal psychosis. Between these two extremes lies postnatal depression (PND), which can itself vary in severity. The purpose of this is to give some information about the possible causes, symptoms and treatments for puerperal psychosis.
What is the incidence of puerperal psychosis?
Puerperal psychosis is fortunately a relatively rare illness, and affects only between one and three mother per thousand.
What are the causes of puerperal psychosis?
The cause of puerperal psychosis is not known with absolute certainty. However it is generally agreed that a sudden drop in the pregnancy hormones (progesterone, oestrogen, etc) probably triggers it immediately after delivery. Women with a previous or family history of mental illness are at a higher risk of developing puerperal psychosis, particularly if they had a previous episode associated with childbirth, but it can also occur in women with no previous or family history of mental illness.
The onset of puerperal psychosis is usually very sudden, and in more than 80% of cases within the first two weeks after delivery. Occasionally onset may be more gradual and the illness may go undetected for several weeks or, rarely, months.
What are the symptoms of puerperal psychosis?
The symptoms of puerperal psychosis vary, but they are usually quite florid. Manic or depressive symptoms tend to dominate, but occasionally there may be psychotic symptoms or a combination of these.
If the mother becomes manic, she will seem very excited and elated and it may be difficult to persuade her that anything is wrong. She will often talk very quickly, not completing sentences, jumping from one subject to another. She may be overactive, not eating, not sleeping, and rushing from one task to another. She may believe that she is invulnerable and capable of anything - driving at 100mph down the motorway, spending money like water. Attempts to control or restrain her may result in violent or abusive outbursts.
Often a manic phase may be followed by a severely depressive phase. The mother may become withdrawn and unresponsive. She may spend long periods of the day crying uncontrollably or staring blankly into space. Speech and thought become slow and she may find it difficult to concentrate, or to remember things. Her appetite may also be affected - she may either feel unable to eat or may binge uncontrollably. Sleep patterns are frequently disturbed, many mothers suffer from insomnia, others want to sleep all day, but feel unrefreshed by sleep.
She may also become intensely anxious, and panicky. Obsessional, inappropriate thoughts may cause her acute distress and she may feel detached from the baby, her partner and reality.
She is likely to feel intensely guilty and inadequate, ashamed of her ability to care for her baby and herself. She may become suicidal or consider killing her baby.
Occasionally women suffering from puerperal psychosis experience delusions or hallucinations. She may become convinced that she has not had a baby, that she has been given the wrong baby, or that she has given birth to Jesus Christ or the Devil. She may feel that she herself has somehow become contaminated and evil, and that she is contaminating those around her. Or she may believe that her partner and family are trying to kill or harm her or the baby. She may hear voices or see people and things which are not there.
In this state of severe mental confusion, she may be a risk to herself, her baby and those around her and will need urgent medical treatment.
What treatment is available for puerperal psychosis?
The mother will usually be admitted to a specialist mother and baby unit, where the mother will be treated by a team with a specialist knowledge of and interest in postnatal mental illness. The length of stay will vary, but the average is around 6-8 weeks.
Treatment of puerperal psychosis will involve one or a combination of the following:
- Drugs - depending on the mothers symptoms, she is likely to be treated with a cocktail of different drugs. These may include a mood stabiliser, anti-psychotics which help to control the symptoms of mania and anti-depressants. The main aim of the drugs is to stabilise the mother, to restore normal appetite and sleep, reduce anxiety and hypomania and to lift mood. Response to mood stabilisers and anti-psychotics is usually rapid but anti-depressants can take several weeks to work.
- ECT - Electro-convulsive therapy is sometimes used with good effect. Although the idea may be frightening, the treatment itself is quite painless as it is administered under general anaesthetic and muscle relaxant. Treatment may be followed by a headache, nausea and temporary memory loss but these effects are usually short lived.
- Hormonal therapy - a great deal of controversy still surrounds the efficacy of hormonal treatment for postnatal illness but it is generally not thought to be effective in treating puerperal psychosis. Hormone replacement may, however, have a role to play in preventing puerperal psychosis and experimental trials are currently being conducted on Oestrogen prophylaxis.
- Additional therapies - once the woman's condition has been successfully stabilised, she is likely to be offered additional therapies aimed at helping her to re-establish control over her life. These may include relaxation classes, talking therapies, group therapy and occupational therapy.
For more information complete our online enquiry form or telephone us on 01323 430831.