POSTPARTUM PSYCHOSIS

INTRODUCTION
Postpartum psychosis is a severe mental illness which develops acutely in the early postnatal
period. It is a psychiatric emergency. Identifying women at risk allows development of care
plans to allow early detection and treatment. Management requires specialist care. Health
professionals must take into account the needs of the family and new baby, as well as the risks of
medication whilst breast-feeding.

DEFINITION
Postpartum psychosis (also sometimes referred to as puerperal psychosis or postnatal psychosis)
is an acute mental disorder or a psychotic reaction occurring in a woman following childbirth, or
abortion. The episode of psychosis usually begins 1 to 3 months of delivery.

INCIDENCE RATE
An estimated 1 to 2 out of every 1,000 women experience postpartum psychosis after giving
birth. The condition is rare and usually occurs within two to three days of delivery.

POSTPARTUM PSYCHOSIS VS. POSTPARTUM DEPRESSION

Doctors have identified several types of postpartum psychiatric illness. Some common terms you
may have heard of include:

Postpartum blues

An estimated 50 to 85 percent of women experience the postpartum blues within a few weeks of
delivery. Symptoms associated with the postpartum blues or “baby blues” include:

 tearfulness
 anxiety
 irritability
 quick changes in mood

Postpartum depression
When depression symptoms last more than two to three weeks and impair a woman’s
functioning, she may have postpartum depression. Symptoms associated with the condition
include:
 consistently sad mood
 feelings of guilt
 worthlessness, or inadequacy
 anxiety
  sleep disturbances and fatigue
 difficulty concentrating
 appetite changes
 A woman with postpartum depression also may have suicidal thoughts.

Postpartum psychosis

Most doctors consider postpartum psychosis to have the most severe mental health effects.
It’s not uncommon for all new mothers to have episodes of sadness, fear, and anxiety.

ETIOLOY
The precise cause is unknown. However, the following serve as risk factors to the development
of postnatal psychosis:

 Genetic/Hereditary, e.g., chromosome 16

 Hormonal changes, e.g., estrogen, progesterone, etc.
 Family/Personal history of depressive episodes
 Low sense of self-esteem due to a woman’s postpartum appearance
 Feeling inadequate as a mother
 Financial problems
 Poor marital relationship
 Single parent
 Childcare stress
 Prenatal anxiety
 Prenatal depression (during pregnancy)
 Unplanned/unwanted pregnancy
 Substance abuse
 Infection
 Have a traumatic birth or pregnancy
 Side effects of medication

SIGNS & SYMPTOMS

 Feeling of inadequacy, e.g., the feeling of being unable to cope with the baby and the
daily requirements, also carrying out other activities, such as self-care and managing the
household
 Hallucinations, e.g., auditory – commanding the patient to kill baby
 Delusions, e.g., baby is a Messiah, or an embodiment of evil
 Illogical thoughts
  Insomnia
 Irritability
 Confusion
 Memory impairment
 Disorientation
 Sadness
 Fatigue/Exhaustion
 Agitations/Feelings of anxiety
 Extreme fear and Ecstasy
 Irrational guilt
 Mutism
 Stupor
 "Flat affect," or a lack of emotional response or blank facial expression
 Difficulty responding emotionally to the baby
 Difficulty sleeping beyond the normal interrupted sleep of new motherhood
 Changes in appetite or eating
 An inability to bond with baby
 Thoughts of suicide, or the belief that the baby or the family would be better off without
the mother

DIAGNOSTIC EVALUATION
1. History taking
A doctor will start by asking you about your symptoms and how long you’ve been
experiencing them. They will also ask about your past medical history, including if you’ve
had any history of:
 depression
 bipolar disorder
 anxiety
 other mental illness
 family mental health history
 thoughts of suicide, or harming your baby
 substance abuse

2. Blood test
Blood testing for thyroid hormone levels, white blood cell counts, and other relevant
information

3. Physical examination

MANAGEMENT

1. Rapid/Immediate hospitalization – if she is thought to pose a threat to baby, herself or

others
 2. Medications

 Antipsychotics: to help with manic and psychotic symptoms, such as delusions or

hallucinations include risperidone, olanzapine, ziprasidone etc.

 Antidepressants: to help ease systems of depression

 Mood stabilizers: These medications reduce manic episodes. Examples include

lithium (Lithobid), carbamazepine (Tegretol), lamotrigine (Lamictal), and
divalproex sodium (Depakote).

3. Cognitive behavioral therapy

CBT is talking therapies that can help you manage your problems by changing the
way you think and behave.

4. Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a more invasive type of brain stimulation that's
sometimes recommended if all other treatment options have failed, or when the situation
is thought to be life threatening.

5. Counseling with a psychiatrist, psychologist, or other qualified mental health

professional.

SUPPORTING PEOPLE WITH THEIR RECOVERY

People with postpartum psychosis will need support to help them with their recovery. You can
help your partner, relative or friend by:
 being calm and supportive
 taking time to listen
 helping with housework and cooking
 helping with childcare and night-time feeds
 letting them get as much sleep as possible
 helping with shopping and household chores
 keeping the home as calm and quiet as possible
 not having too many visitors

COMPLICATION
 Suicide
 Infanticide
 Lack of normal mother- infant bond
 Marital/ family problems
NURSING DIAGNOSIS

1. Impaired parenting related to the inability to perform activities of daily living

secondary to postpartum depression.

Goal- Patient can perform her activities of daily living.

Intervention

 Assist the woman in planning for her daily activities, such as her
nutrition program, exercise, and sleep.
 Recommend support groups to the woman so she can have a
system where she can share her feelings.
 Advise the woman to take some time for herself every day so she
can have a break from her regular baby care.
 Encourage the woman to keep in touch with her social circle as
they can also serve as her support system.

2. Altered sleep and rest related to depressed mood and depressive cognitions
evidenced by difficulty in falling asleep, early morning awakening.
Goal: Patient will sleep adequately during the night.

Interventions:

 Plan daytime activities according to the patient’s interests

 Ensure a quite and peaceful environment when the patient is preparing for sleep
 Provide comfort measures like back rub, warm milk etc.
 Don’t allow the patient to sleep for long time during the day
 Give prescribed sedatives

3. Impaired social interaction related to lack of support systems as evidenced by

dysfunctional interaction with family

Goal- Patient will identify feelings that lead to poor social interactions.
Interventions:
  Provide activities that require minimal concentration (e.g., drawing,
playing simple board games).
 Eventually involve the client in group activities (e.g., group discussions, art therapy,
dance therapy).
 Eventually maximize the client’s contacts with others (first one other,
then two others, etc.).
 Refer the client and family to self-help groups in the community.

4. Disturbed thought process related to delusion or illogical thoughts.

Goal- Patient maintains reality orientation and communicates clearly

with others.
Interventions:

 Reorient to time/ place as needed.

 Have patient write name periodically; keep this record for comparison and report
differences.
 Schedule structured activity and rest periods.
 Reduce provocative stimuli, negative criticism, arguments, and
confrontations.
 Engage the patient in one-to-one activities at first, then activities in
small groups, and gradually activities in larger groups.
RESEARCH ARTICLES

Sleep loss and postpartum psychosis

Verinder Sharma 

Dwight Mazmanian

Abstract

Postpartum psychosis is a rare but severe psychiatric disorder. Its diagnostic status remains
controversial, but several studies have shown that the majority of patients who develop psychosis
immediately following childbirth suffer from bipolar disorder. The pathophysiology of
postpartum psychosis is poorly understood, but factors such as primiparity, difficult labor,
genetic predisposition, and hormonal changes have been suggested as etiological factors. This
paper reviews the literature on the relationship of sleep disruption and postpartum psychosis. It is
argued that sleep loss resulting from the interaction of various putative causal factors may be the
final common pathway in the development of psychosis in susceptible women. Clinical
significance of these findings, including strategies to prevent postpartum psychosis, are
discussed and suggestions are made for future research directions.
CONCLUSION

Giving birth to a baby brings about many changes, and these can include changes in a new
mom’s mood and emotions. Some women experience more than the normal ups and downs of
the postpartum time period. Many factors play a role in postpartum mental health. During this
time, the most severe end of the change spectrum is a condition known as postpartum psychosis,
or puerperal psychosis.
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Jabalpur institute of nursing sciences and
research
Subject: - mental health nursing

TOPIC PRESENTATION ON-

POSTPARTUM PSYCHOSIS

SUBMITTED TO- SUBMITTED BY-

MRS. SHARIKA RATISH PREETI SHARMA

ASST. PROFESSOR M.Sc. NSG 1ST YEAR

JINSAR JINSAR
SUBMITTED ON-