POSTNATAL PSYCHOSIS

Postpartum psychosis is the most severe form of postpartum psychiatric illness.

Causes

  • Not well known, but hormonal changes may have a role

Predisposing factors

  • First child
  • Previous episode of post natal psychosis
  • Previous major psychiatric history
  • Family history of mental illness
  • Inadequate psychosocial support during pregnancy
  • Infections in early puerperium

Clinical features

  • Symptoms develop within the first 2 postpartum weeks (sometimes as early as 48-72 hours after delivery)
  • The condition resembles a rapidly evolving manic or mixed episode with symptoms such as restlessness and insomnia, irritability, rapidly shifting depressed or elated mood and disorganized behavior
  • The mother may have delusional beliefs that relate to the infant (e.g. the baby is defective or dying, the infant is
    Satan or God) or she may have auditory hallucinations that instruct her to harm herself or her infant
  • The risk for infanticide and suicide is high

Differential diagnosis

  • Depression with psychotic features
  • Mania, chronic psychosis

Investigations

  • Good history, physical and psychiatric assessment

Management

  • It is a psychiatric emergency: admit to hospital
  • Treat any identifiable cause/precipitant e.g. infection
  • Haloperidol 10 mg or Chlorpromazine 200 mg [Intramuscular Injection or tablets} every 8 or 12
    hours. Monitor response to medication and adjust dosage accordingly
  • If restless and agitated, add rectal or I.V Diazepam 5-10 mg slow infusion; repeat after 10
    minutes if still agitated

    • Continue with diazepam tablet 5 mg every 12 hours until calm
  • Refer to specialist
Notes
  • Post-natal psychoses are no different from other similar psychoses, give concurrent psychosocial interventions
    and drug therapy

Prevention

  • Proper antenatal screening, good psychosocial support
  • Early detection and treatment
  • Adherence to treatment for a current mental illness e.g depression, bipolar, chronic psychosis