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-term period of mild depression following the birth of a child. Ten percent develop postpartum depression, a more serious condition that can include mood swings, uncontrollable crying, fatigue or exhaustion, feelings of guilt, inadequacy or worthlessness, lack of interest in the baby and other common signs of depression. One or two in a thousand women will develop postpartum psychosis - a very serious illness that needs quick intervention, usually including hospitalization. One or two in a thousand may not sound like many until you know that in 2004 there were just over 4.1 million births in the United States. This translates to 4,100 to 8,200 women who experience postpartum psychosis per year. Given the rates of suicide and infanticide related to postpartum psychosis, this estimates at risk over 300 infants killed and more than 400 mothers committing suicide because of this illness each year in the US alone. Causes and Risk Factors of Postpartum Psychosis Although more studies are needed to determine the causes of postpartum illnesses, the evidence suggests that the sudden drop in estrogen levels that occurs immediately after the birth of a child plays a significant role, along with sleep disruptions that are inevitable before and after the birth. Many researchers conclude that postpartum psychosis is strongly related to the bipolar spectrum. Indeed, one theory is that new mothers who have psychotic episodes and dramatic mood swings are actually experiencing their first bipolar episodes, with the manic-depressive illness having been "dormant" beforehand and triggered by childbirth. In fact, for 25% of women who have bipolar disorder, the condition began with a postpartum episode (Sharma and Mazmanian). One of the biggest risk factors for postpartum psychosis is previously diagnosed bipolar disorder or schizophrenia, along with a family history of one of these conditions. Also, women who have already experienced postpartum depression or psychosis have a 20-50% chance of having it again at future births. Symptoms of Postpartum Psychosis Symptoms of postpartum psychosis are consistent with those of a bipolar I psychotic episode but have some special "twists" specifically related to motherhood. They include, but are not limited to:
• • • • • • •
Hallucinations Delusions Periods of delirium or mania Thoughts of harming the baby or oneself Irrational feelings of guilt Refusing to eat Thought insertion - the notion that other beings or forces (God, aliens, the CIA, etc.) can put thoughts or ideas into one's mind • Insomnia - although studies are beginning to show that insomnia may be a cause rather than an effect • Reluctance to tell anyone about the symptoms
where the sufferer can maintain her role as a mother and build up her relationship with the newborn. Yet multiple factors must be considered in the subsequent discharge plan to ensure the safety and healthy development of both the baby and its mother. The location of treatment is an issue: hospitalization is disruptive to the family. round the clock. Mothers who suffer a puerperal episode are liable to other manic depressive or acute polymorphic episodes. A small minority follow a relapsing pattern. some of which occur after other children are born. Electro-convulsive (electroshock) treatment is highly effective. Mood stabilizing drugs such as lithium are also useful in treatment and possibly the prevention of episodes in women at high risk (i. and some unrelated to childbearing. these psychoses can last many months. baby.. Infanticide after childbirth is usually due to profound postpartum depression (melancholic filicide) when it is often accompanied by suicide. This requires the presence. If hospital admission is necessary. some during pregnancy or after an abortion. of competent adults (such as the baby's maternal grandmother).Without treatment.[ . but they should be used with caution because of the danger of severe side effects including the neuroleptic malignant syndrome. It does occur. but with modern therapy they usually resolve within a few weeks. there are advantages in conjoint mother and baby admission. and it is possible to treat moderately severe cases at home. or over 50% if depressive episodes are included. and frequent visits by professional staff. their relationship and the entire family. usually related to the menstrual cycle. during these episodes. Severe overactivity and delusions may require rapid tranquilization by neuroleptic (antipsychotic) drugs. Suicide is rare. This plan often involves a multidisciplinary team structure to follow-up on mother. women who have already experienced manic or puerperal episodes). Puerperal recurrences occur after at least 20% of subsequent deliveries.e. and infanticide extremely rare. as illustrated by the famous cases summarized below.