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What is puerperal psychosis?
This is the most severe type of postnatal illness. It is very uncommon and is characterized by an altered mental state with manic or depressive features or both (alternating). Admission to a psychiatric unit in hospital is almost always required.
What are the manic features of puerperal psychosis?
Manic features (or reaction) will include a manifestation of euphoria or excitement. The new mother is very jolly. There is rapid turnover of thoughts and before one is fully expressed, another one takes its place. Speech also follows suit and these patients characteristically talk very quickly, to an extent that it may be difficult to follow. The speech may soon become disjointed and impossible to follow.
She will be over-active and may not even find time to eat. Sleep is also dispensed with. Progressively, her activities may become destructive. There may be grandiose ideas, which may trigger a spending spree that she might ill-afforded.
She may become offended quite easily and this may prompt uncharacteristic obscene language, or sometimes aggressive behaviour.
What are the depressive features (reaction) of puerperal psychosis?
The mother feels down and dejected. She cannot bring herself to smile, laugh or relax, whatever the amount of encouragement to do so. She will spend most of the day in tears and has unpredictable feelings of panic.
She feels inadequate, incompetent and utterly unable to cope. This makes her feel guilty and ashamed. She feels unable to concentrate and will continually worry about poor memory. She may develop obsessional thoughts or rituals that may cause much distress.
Sleeping patterns may be altered, with inability to sleep being the more common feature, but others actually want to sleep round the clock.
Appetite may be decreased, but sometimes the opposite is the case. Probably most worrying is the mother's inability to feel affection for her baby and she may feel profound guilt as a result. She is unable to bond with her baby, as there are no maternal feelings at all. In severe cases, the mother may harbour suicidal thoughts and even the baby's life may be at risk.
What about the so-called schizophrenic reaction?
Sometimes patients with puerperal psychosis will exhibit delusions (false beliefs) and/or hallucinations (faulty perceptions). She may deny ever having had a baby or may claim that the baby is a monster. Others insist that they have been given the wrong baby. All sorts of delusions and hallucinations may be manifest.
How is this condition treated?
Treatment will depend on the severity and the various circumstances in each individual case. There are several facets that may be employed in the treatment but the mainstay will be supportive therapy and drugs.
Antidepressant medication may be prescribed and administered, first in hospital, then, with adequate improvement, as an outpatient. The family should support and encourage the patient to continue with medication and complete the recommended course. A network of support should be put in place and this may include a number of care-givers, including the midwife, health visitor,, family doctor, obstetrician, psychiatrist and district nurse. Each will have their role to play.