Postpartum or puerperal psychosis: causes, symptoms and treatment

Symptoms of psychosis rarely appear in women in the period immediately following childbirth. Although psychiatric textbooks do not consider puerperal psychosis to be a specific disorder, many professionals use this concept to refer to these situations.

In this article we will analyze the main symptoms and causes of puerperal psychosis, As well as other basic features. We will also briefly review the treatment options currently available to manage this problem.

    What is puerperal psychosis?

    Postpartum or puerperal psychosis is a type of psychotic disorder that occurs in women who have just had a baby, usually within two weeks of giving birth. It is characterized by typical symptoms of psychosis such as hallucinations, delusions, disorganization of thought, behavioral inhibition and catatonia.

    In psychotic disorders, there is a loss of contact with reality which can manifest in different areas and has varying severity. It is believed that there is a strong genetic influence that determines the development of symptoms of psychosis.

    This form of psychosis was first described by German obstetrician Friedrich Benjamin Osiander in 1797. In the past, puerperal psychosis was attributed to infections, thyroid disorders or eclampsia, a convulsive disorder of pregnancy; although these hypotheses have been ruled out (except for the thyroid), the causes remain unclear.

    This is a relatively rare alteration, as affects 1 in 1,000 women who give birth. Compared to postpartum depression, a subtype of major depressive disorder, it occurs in about 15% of mothers. Although psychotic symptoms can appear against the background of postpartum depression, they are different disorders.

    The DSM manuals do not include the diagnosis of puerperal psychosis; use of these guidelines should classify these cases as “unspecified psychotic disorders”. In ICD-10 we find the category “Mental and Behavioral Disorders of the Puerperium”, which also includes postpartum depression.

      Common symptoms and signs

      The referred symptoms and observable signs of puerperal psychosis vary widely depending on the individual case, and even over the course of the disorder in a single person. Opposite symptoms, such as euphoria and depression, sometimes occur together.

      The most common early signs of postpartum psychosis they include the onset of feelings of euphoria, reduced drowsiness, mental confusion and verbiage.

      In addition to being classifiable as a psychotic type similar in nature to schizophrenia or schizoaffective disorder, the usual symptoms of puerperal psychosis are sometimes they also resemble those of mania and depression, The main mood swings.

      • Delusions and other strange beliefs
      • Hallucinations, especially auditory type
      • Paranoia and suspicion
      • Irritability and emotional instability
      • Low mood, even when depressed
      • Mania: feeling of euphoria, increased energy and psychological restlessness
      • Fast 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 shows that puerperal psychosis it is associated with schizophrenia, bipolar disorder and schizoaffective disorder; 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 to this disorder, as having a close relative diagnosed with puerperal psychosis increases the risk of developing it by about 3%. A family history of depression during pregnancy or postpartum, psychotic and affective disorders, and thyroid dysfunction are also risk factors.

      However, half of the women who suffer from postpartum psychosis have no risk factors; one hypothesis that could explain it would be the one that associates this disorder with hormonal and sleep cycle changes that occur after childbirth. First-time mothers seem 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 prolonged or the mother is hospitalized again. Usually, the management of this disorder is through drug therapy, although there are emergency psychological intervention programs for psychosis that can be very helpful as a supplement.

        Among the drugs used to treat this disorder, there are two categories: antipsychotics and mood stabilizersReference Psychopharmaceuticals in Bipolar Disorder. Antidepressants can also be helpful in managing symptoms such as depressed mood, irritability, sleep disturbances, and cognitive problems.

        Drug-resistant cases that are also severe, such as those with a clear 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 markedly within three months of giving birth. The risk of suicide remains high during the recovery period.

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