27 May Postpartum Psychosis: What Is It and How Common Is It?
No family, friend or partner wants to think about the possibility of their loved one suffering from postpartum psychosis. And, the truth is, it’s rare, affecting 1-2 women out of 1000. Perhaps the most famous case of postpartum psychosis is that of Andrea Yates, a mother of 5, who drowned each of her children in the family bathtub. They ranged in ages from 7 years old to 6 months.
Postpartum psychosis (PPP) is a psychiatric emergency that requires immediate hospitalization and pharmaceutical treatment such as mood stabilizers and anti-anxiety medications. PPP most often occurs in the first 2 weeks postpartum and the risk is increased with multiple pregnancies.¹
The lives of both the mother and infant are at risk because of the risk of suicide and infanticide (when a mother kills her infant). Because of this it’s important to identify mothers who are at risk for PPP and to know the symptoms, so medical help can be sought immediately.
What are the Symptoms/Signs of Postpartum Psychosis?
Women who have a history of Bipolar disorder are at risk for postpartum psychosis and most women with PPP go on to be diagnosed with Bipolar disorder.² The onset of PPP after giving birth is thought to occur due to hormonal, immunological (thyroid imbalances, infections), and circadian changes in genetically vulnerable women.¹ Circadian rhythms are the physical, mental and behavioral changes that the body goes through in a 24 hour cycle. Sleep deprivation associated with motherhood can profoundly impact this cycle.
Postpartum psychosis is unique in that its symptoms are more extreme than postpartum anxiety or depression. Postpartum depression and anxiety is certainly a strong risk factor and often at the core of PPP. Sometimes, when these conditions are unaddressed, the psychotic features of PPP can emerge. A mother with active psychotic symptoms means she is mentally unstable and cannot provide safe care to her infant. Common psychotic features include:
- auditory and visual hallucinations (25%)
- paranoia and delusions (50%)
- delirium and disorientation
- suicide and infanticide (5%).²
PPP can begin like postpartum depression symptoms: fatigue, insomnia, restlessness, tearfulness and mood swings. But it can progress to paranoia and delusions, such as suspiciousness, irrational thoughts, and obsessive concerns about the health of the baby. Some mothers may think the baby is possessed by a demon, holds special powers, or obsess over something bad happening to the baby. Some mothers may accuse nurses or family of hurting the baby. Increased confusion and incoherence continue, until thinking becomes so disorganized that the mother is disinterested or unable to provide safe care to her baby.²
It’s important to know that at this stage, a mother may not be able to make sound decisions in the best interest of herself and her baby, such as seeking medical intervention. If a mother is having active suicidal ideation or harmful delusions that put her or her baby at risk, and she is unwilling to seek medical treatment, legal intervention is sometimes necessary to get her the care she needs, such as admission to an inpatient psychiatric setting.
That of course, is a last resort, when early signs of PPP have gone undetected. With early detection and medical treatment, postpartum psychosis has a good prognosis for recovery. Check out these screening tools for postpartum mood disorders, which take about 5-10 minutes to complete:
- Edinburgh Postpartum Depression Scale
- Postpartum Depression Screening Scale (from your healthcare provider)
Above all, if you are a new mother who is suffering from symptoms of a postpartum mood disorder or a concerned family or friend who has noticed negative changes in your loved one, don’t stay silent. Reach out to a medical provider and search for mental health support in your area. Help is available and you can find healing and renewed hope to make a full recovery.
REFERENCES:
- Lowdermilk et al. (2016). Maternity and women’s health care. Elsevier Inc.
- National Institute of Health (NIH). (September 2018). Recognizing and managing postpartum psychosis: a clinical guide for obstetric providers. https://pubmed.ncbi.nlm.nih.gov/30092921/
- Photo by cottonbro studio: https://www.pexels.com/photo/light-man-love-people-6763607/
