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Postpartum Psychosis

postpartum psychosisAccording to the DSM-5, psychotic disorders are defined as abnormalities in one or more of five different domains: delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms.[1] However, the current psychiatric systematic classification of diseases does not recognize postpartum psychosis as a distinct disorder.1

The prevalence of postpartum psychosis in the general population is between 0.1 percent and 0.2 percent, a number significantly lower than postpartum depression.1 In fact, postpartum psychosis is one of the rarest psychiatric disorders; however, it is always considered a psychiatric emergency due to its rapid onset and potential for catastrophic outcome, such as infanticide or suicide.1

Postpartum psychosis is the presentation of a psychotic disorder in women.1 However, those who have been diagnosed with schizophrenia or another psychotic disorder previously experience a 25 percent risk of exacerbated symptoms.1 Postpartum psychosis is known to occur in 20 to 30 percent of women with known bipolar disorder and a family history of postpartum psychosis.1

Also, once a woman has experienced an episode of postpartum psychosis, the risk of recurrence in the next pregnancy exceeds 50 percent.1 Depressive episodes often follow the acute psychotic symptoms, and 26 percent who receive pharmacotherapy remain symptomatic for up to one year after delivery.1

In 65 percent of cases, postpartum psychosis has an acute onset within the first two weeks after delivery; however, onset can occur as early as postpartum day one.1 The clinical features include elated, dysphoric, or labile mood; insomnia; agitation, and bizarre behavior.1 Psychotic symptoms include mood-incongruent delusions with frequent content related to the infant, through ideas of reference, delusions of control, broadcasting, or command hallucinations.1 Often, the patient’s thought process is disorganized, and they are confused, perplexed, and have cognitive clouding.1 Unfortunately, 4 percent of women with postpartum psychosis commit infanticide and five percent commit suicide.1

Even the smallest change in the mental status of a woman who has just given birth requires careful consideration of potential underlying psychiatric issues.1 All medical issues must be ruled out before a psychiatric diagnosis can be made.1 Oftentimes, antipsychotics, mood stabilizers, and benzodiazepines are the interventions of choice.1 A quick remission of symptoms is important, so that the mother can improve functioning and continue to bond with and care for her new child.1

A regular sleep pattern and engaging family members is also key.1 While it is often difficult to care for an ill mother and a newborn child, it is important for family members to understand the reasoning behind it and the importance of care.1 The mother will need a strong support system in order to achieve remission.1

Initially, separation from the newborn may be necessary; therefore, family support is an important source of reassurance for the mother once their mental status begins to improve.1 Many mothers do not remember the details of what happened during an episode of acute psychosis, and will need confidence in her ability to recover and mother the child appropriately.1 Continued support and education regarding postpartum psychosis are key as recovery continues.1

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