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uk/puerperal_psychosis

Puerperal psychosis

What is puerperal psychosis? Who experiences this sort of psychosis? What causes puerperal psychosis? How is it treated? Staying in hospital Preparing for puerperal psychosis

What is puerperal psychosis?

Some women experience the symptoms of psychosis almost immediately after giving birth. An episode of psychosis following the birth of a baby is called puerperal psychosis. It is also called postpartum psychosis or postnatal psychosis. Puerperal psychosis is totally different from postnatal depression (though women who experience puerperal psychosis may feel depressed). Women normally start experiencing symptoms of puerperal psychosis between three and seven days after the birth, and it starts very suddenly. The risk of experiencing puerperal psychosis ends after about three months. The symptoms usually include insomnia, feeling agitated, restless and irritated, feeling depressed or unusually happy, and swinging rapidly between these states of mind. Women with puerperal psychosis may behave strangely, feel very confused, and experience fleeting hallucinations. They may worry excessively, and believe that something is wrong with their baby. They may avoid their baby and find it hard to bond with them. In severe cases, they may try to harm themselves, or try to harm their child. Back to top

Who experiences this sort of psychosis?

Women who currently have a diagnosis of bipolar disorder or schizoaffective disorder may experience puerperal psychosis after the birth of their first child. For them, this is a relapse of the illness that is triggered by the delivery. Women who have been given a diagnosis of bipolar disorder of schizoaffective disorder in the past may also experience a relapse following birth. An episode of puerperal psychosis follows between 25 and 50 per cent of births to women who have bipolar or schizoaffective disorder.

Women who experienced puerperal psychosis after the birth of their first child will almost inevitably experience it again following the birth of a second child, and after subsequent births. About one in every 1,000 women who have no history of mental ill health will develop puerperal psychosis. For some of these women, this represents the first episode of bipolar disorder or schizoaffective disorder. Others will never experience an episode of psychosis again, or will only experience a relapse following the birth of a second child. If there is a family history of puerperal psychosis, the risk of developing it is higher: research has shown that women are more likely to experience puerperal psychosis if their mothers or other close relatives did. This applies equally to women who have no previous personal experience of mental illness. There is no greater risk of developing puerperal psychosis if a womans mother or other close relative has experienced postnatal depression or other postnatal mental health problems. Back to top

What causes puerperal psychosis?

Researchers think puerperal psychosis is somehow caused by changes in hormones that happen during pregnancy and birth, but as yet they do not know what these changes are. Studies have shown that puerperal psychosis is genetic that women whose mothers or close relatives experienced psychosis after birth are more at risk of developing it themselves. However, researchers do not yet know which genes are involved. Researchers are trying to understand more about the causes of puerperal psychosis why one woman with bipolar disorder will experience it, and another woman with the same diagnosis wont, for example. Back to top

How is it treated?
Treatment for puerperal psychosis involves antipsychotic medication and drugs used to treat bipolar disorder (see Medication page). Women may not be able to breast-feed while taking some medication, and their psychiatrist should give advice about this. ECT (electroconvulsive therapy) is sometimes used to treatment symptoms of puerperal psychosis that do not respond to medication (see Other treatments page for information about ECT). With treatment, most women become well within several months. Back to top

Staying in hospital

Women who experience puerperal psychosis may be given treatment in hospital. There are special mother and baby units within the NHS where women can be cared for with their child by specialist perinatal mental health staff (perinatal means immediately before and after birth 'peri' means 'around'). Mother and baby units are not available everywhere, but many hospitals will try to arrange a transfer to the nearest unit for a woman who has puerperal psychosis. A woman will probably stay on a mother and baby unit for four to eight weeks while the symptoms are treated. During this time, staff on the mother and baby unit will also help her to build a relationship with her baby: women may initially feel detached from their child as a result of the symptoms of puerperal psychosis. If a mother and baby unit is not available, women may stay on an obstetric ward to be cared for. If a woman is very agitated, or the symptoms she is experiencing mean it is not safe for her to be with her baby, she may be admitted to a psychiatric ward while her baby is cared for by family members. If she has no support at home, social services may need to arrange temporary care for the baby while the mother is given treatment. Temporary care should be a last resort. Women who have experienced puerperal psychosis will stay under the care of communitybased mental health professionals after discharge from a mother and baby unit or hospital until they become well. Back to top

Preparing for puerperal psychosis

Women with a diagnosis of bipolar disorder or schizoaffective disorder should talk to their psychiatrist and obstetrician about the possibility of experiencing puerperal psychosis after birth. Ideally, they should discuss plans to have a baby with their psychiatrist before they become pregnant. Some medication prescribed for bipolar disorder valproate, for example should not be taken during pregnancy as it may harm the developing baby. Women may therefore need to change medication during pregnancy and their psychiatrist will advise on alternative drugs. Women who have experienced puerperal psychosis after the birth of their first child are very likely to have symptoms following future births. This means they can prepare in advance with the support of mental health professionals and family members. This preparation could involve starting, or optimising medication immediately after the birth. Because the risk of puerperal psychosis is highest straight after birth, health professionals may arrange for women to stay for a few days longer on an obstetric ward where support from a hospital-based psychiatrist is available at all hours. Or, if a woman is discharged, members of a community mental health team may visit on a daily basis to make sure any symptoms are spotted and treated immediately. There are dedicated perinatal psychiatry teams employed by mental health trusts throughout the country who can give expert advice about preventative measures and can help coordinate

care of women at risk of developing puerperal psychosis. A GP, obstetrician or care coordinator will be able to say what is available locally.