INTRODUCTION :

                 Postpartum psychosis is a clinical syndrome that occurs after child birth and is characterized by delusions (false beliefs) and severe depression. Thoughts of wanting to harm the newborn infant or oneself may occur and represent a real danger.

EPIDEMIOLOGY :

Postpartum psychosis occurs in 1 to 2 per 1,000 deliveries. The disorder is fundamentally a disease affecting women, although exceedingly rare cases of postpartum psychosis have been reported in fathers. The risk of a postpartum psychosis is increased if the patient or her mother had a previous postpartum psychiatric illness or if there is a history of a mood disorder in the patient or her family.

CAUSES :-

Most patients with this disorder have an underlying mental illness, most commonly a mood disorder and less commonly schizophrenia. A few cases result from an organic mental syndrome associated with perinatal event. (e.g., infection, drug intoxication, and blood loss). The sudden fall in hormone levels immediately after pregnancy may contribute to the disorder, but treatment with those hormones has not been successful.

Conflicting feeling of the mother about her mothering experience may cause psychosis. Some women may not have wanted to become pregnant; others may feel trapped in an unhappy marriage by motherhood. Marital discord during pregnancy is associated with an increased incidence of illness, husband feels displaced by the child and competitive for the mother’s love and attention.

CLINICAL FEATURE :-

The symptoms usually occur about the third postpartum day. The patient begins to complain of insomnia, restlessness, and feelings of fatigue and shows lability of mood with bouts of tearfulness. Later symptoms include suspiciousness, evidence of confusion, incoherence, irrational statement, and obsessive concerns about wanting to care for the baby, of not loving the baby, and in some cases, of wanting to do harm to the baby, to self or both. Delusional material may involve the idea that the baby is dead or defective. The birth may be denied, and thoughts of being unmarried, virginal, persecuted, influenced, or perverse may be expressed. Hallucinations may occur with similar content and may involve voices telling the patient to kill her baby.

COURSE AND PROGNOSIS :--

The onset of frank psychotic symptoms is usually preceded by prodromal signs, such as insomnia, restlessness, agitation, lability of mood, and mild cognitive defects. Once the full blown psychosis occurs, the patient may be a danger to herself or to her newborn, depending on the content of her delusion and agitation. Patients may kill themselves, or the baby. A favorable outcome is associated with a good premorbid adaptation, the absence of depression or schizophrenia, and a supportive family network. Subsequent pregnancies are associated with an increased risk of having another episode; however, most episodes occur to primiparas.

DIAGNOSIS :--

The main diagnostic feature of this disorder is the association with postpartum period. Most cases begin within 30 days of giving birth. Symptoms of cognitive impairment associated with mood changes particularly depression, delusions, and hallucinations (hearing voices which do not exist) with content related to the infant or mother. A premorbid history of the patient’s attitudes about pregnancy and conception, whether the baby was planned, attitudes of the father toward the birth, marital problems, and anticipated life-style changes may be helpful.

TREATMENT :--

Postpartum psychosis is a psychiatric emergency. Antidepressants are the treatment of choice for depressed postpartum patients. Suicidal patients may require transfer to a psychiatric unit to help prevent a suicide attempt. For patients who suffer manic illnesses, lithium therapy, alone or in combination with an antipsychotic agents are indicated. If mother is on medicines breast feeding may be stopped.

It is usually advantageous for the mother have contact with her baby if she so desires. But these visits must be closely supervised, especially if the mother is preoccupied with doing harm to the infant.

Psychotherapy is indicated after the period of acute psychosis is over. Therapy is usually directed at the areas of conflict that have become evident during the period of evaluation. Therapy may involve helping the patient to accept the mothering role or to accept her angry, jealous feelings toward the child as they relate to her thwarted need to depend on her own mother, changes in environment may help to reduce stress. Most studies report high rates of recovery from the acute phase of illness.