postpartum psychosis
TRANSCRIPT
What is Postpartum Psychosis?
Postpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1% of births. The onset is usually sudden, most often within the first 4 weeks postpartum.
This mood disorder affects new mothers indiscriminately. In some cases, the woman that develops postpartum psychosis has no history of depression or other mood disorders. In other cases, a woman may have a latent condition that surfaces as she experiences the hormonal intensity of the postpartum months.
Unfortunately, though many women with the disorder realize something is wrong with them, fewer than 20% actually speak to their healthcare provider. Sadder still is the fact that often postpartum psychosis is misdiagnosed or thought to be postpartum depression, thereby preventing a woman from receiving the appropriate medical attention that she needs.
Women who do receive proper treatment often respond well but usually experience postpartum depression before completely recovering. However, without treatment, the psychosis can lead to tragic consequences. Postpartum psychosis has a 5% suicide rate and a 4% infanticide rate.
What are its Signs and Symptoms?
Although the onset of symptoms can occur at any time within the first three months after giving birth, women who have postpartum psychosis usually develop symptoms within the first two to three weeks after delivery. Postpartum psychosis symptoms usually appear quite suddenly; in 80% of cases, the psychosis occurs three to 14 days after a symptom-free period.
Signs and Symptoms of postpartum psychosis include:
Hallucinations Delusions Illogical thoughts Insomnia Refusing to eat Extreme feelings of anxiety and agitation Periods of delirium or mania Suicidal or homicidal thoughts Hyperactivity Decreased need for or inability to sleep Paranoia and suspiciousness Rapid mood swings Difficulty communicating at times
What are its Causes and Risk Factors?
Experts aren’t exactly sure why postpartum psychosis happens. However, they do offer
a variety of explanations for the disorder, with a woman’s changing hormones being at the top of
their list. Other possible reasons or contributing factors include a lack of social and emotional
support; a low sense of self-esteem due to a woman’s postpartum appearance; feeling
inadequate as a mother; feeling isolated and alone; having financial problems; and undergoing
a major life change such as moving or starting a new job.
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.
Pathophysiology of Psychosis (General)
How is postpartum depression diagnosed?
There is no one test that definitively indicates that someone has PPD. Therefore, health care
professionals diagnose this disorder by gathering comprehensive medical, family, and mental
health history. Patients tend to benefit when the professional takes into account their client's
entire life and background. This includes, but is not limited to, the person's gender, sexual
orientation, cultural, religious, ethnic background, and socioeconomic status. The health care
professional will also either perform a physical examination or request that the individual's
primary care doctor perform one. The medical examination will usually include lab tests to
evaluate the person's general health and as part of screening the individual for medical
conditions that might have mental health symptoms.
Postpartum depression must be distinguished from what is commonly called the "baby blues,"
which tend to happen in most new mothers. In the brief mood problem of baby blues, symptoms
like crying, feeling sad, irritability, anxiety, and confusion can occur. In contrast to the symptoms
of PPD, the symptoms of the baby blues tend to peak around the fourth day after delivery,
resolve by the 10th day after giving birth and do not tend to affect the parent's ability to function.
Postpartum psychosis is a psychiatric emergency that requires immediate intervention because
of the danger that the sufferer might kill their infant or themselves. Postpartum psychosis usually
begins within the first two weeks after delivery. Symptoms of this condition tend to involve
extremely disorganized thinking, bizarre behavior, unusual hallucinations, and delusions.
Postpartum psychosis is often a symptom of bipolar disorder, also called manic depression.
While seasonal affective disorder (SAD) features depression, it takes place at a particular time
of year, typically in the darker winter months.
What are the treatments for postpartum depression?
Educational programs and support groups
Treatment of postpartum depression in men and women is similar. Both mothers and
fathers with this condition have been found to greatly benefit from being educated about the
illness, as well as from the support of other parents who have been in this position.
Psychotherapies
Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to
solve problems and cope with all forms of depression, including postpartum depression. It
can be a powerful intervention, even producing positive biochemical changes in the brain.
This is particularly important as an alternative to medication treatment while women are
breastfeeding. In general, these therapies take weeks to months to complete. More intense
psychotherapy may be needed for longer when treating very severe depression or for
depression with other psychiatric symptoms.
Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the
person with PPD develop more effective skills for coping with social and interpersonal
relationships. IPT employs two strategies to achieve these goals.
The first is education about the nature of depression. The therapist will emphasize that
depression is a common illness and that most people can expect to get better with
treatment.
The second is defining specific problems (such as child care pressures or interpersonal
conflicts). After the problems are defined, the therapist is able to help set realistic goals
for solving these problems. Together, the individual with PPD and his or her therapist will
use various treatment techniques to reach these goals.
Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the
likelihood it will come back by helping the PPD sufferer change his or her way of thinking. In
CBT, the therapist uses three techniques to accomplish these goals.
Didactic component: This phase helps to set up positive expectations for therapy and
promote cooperation.
Cognitive component: This helps to identify the thoughts and assumptions that influence
behaviors, particularly those that may predispose the person with PPD to being
depressed.
Behavioral component: This employs behavior-modification techniques to teach the
individual with PPD more effective strategies for dealing with problems.
Severe overactivity and delusions may require rapid tranquilization by neuroleptic
(antipsychotic) drugs, but they should be used with caution because of the danger of severe
side effects including the neuroleptic malignant syndrome. 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.e., women who have already
experienced manic or puerperal episodes). The location of treatment is an issue: hospitalization
is disruptive to the family, and it is possible to treat moderately severe cases at home, where the
sufferer can maintain her role as a mother and build up her relationship with the newborn. This
requires the presence, round the clock, of competent adults (such as the baby's maternal
grandmother), and frequent visits by professional staff. If hospital admission is necessary, there
are advantages in conjoint mother and baby admission. 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. This plan often involves a multidisciplinary team structure to follow-up on
mother, baby, their relationship and the entire family.
Nursing Interventions for Postpartum Psychosis
Prevention
1.0 Nurses provide individualized, flexible postpartum care based on the identification of
depressive symptoms and maternal preference.
2.0 Nurses initiate preventive strategies in the early postpartum period like having maternal
classes
Confirming
3.0 The Edinburgh Postnatal Depression Scale (EPDS) is the recommended Depressive
Symptoms self-report tool to confirm depressive symptoms in postpartum mothers.
4.0 The EPDS can be administered anytime throughout the postpartum period (birth to 12
months) to confirm depressive symptoms.
5.0 Nurses encourage postpartum mothers to complete the EPDS by themselves in privacy.
6.0 An EPDS cut-off score greater than 12 may be used to determine depressive symptoms
among English-speaking women in the postpartum period.
This cut-off criterion should be interpreted cautiously with mothers who:
1) are non-English speaking; 2) use English as a second language, and/or
3) are from diverse cultures.
7.0 The EPDS must be interpreted in combination with clinical judgment to confirm postpartum
mothers with depressive symptoms.
8.0 Nurses should provide immediate assessment for self harm ideation/behaviour when a
mother scores positive (e.g., from 1 to 3) on the EPDS self-harm item number 10.
Treatment
9.0 Nurses provide supportive weekly interactions and ongoing assessment focusing on mental
health needs of postpartum mothers experiencing depressive symptoms.
10.0 Nurses facilitate opportunities for the provision of peer support for postpartum mothers with
depressive symptoms.
General
11.0 Nurses facilitate the involvement of partners and family members in the provision of care
for postpartum mothers experiencing depressive symptoms, as appropriate.
12.0 Nurses promote self-care activities among new mothers to assist in alleviating depressive
symptoms during the postpartum period.
13.0 Nurses consult appropriate resources for current and accurate information before
educating mothers with depressive symptoms about psychotropic medications.
Education Recommendations
14.0 Nurses providing care to new mothers should receive education on postpartum depression
to assist with the confirmation of depressive symptoms and prevention and treatment
interventions.
Teaching Learning Guide
Topic:__________________________________________
Name of Reporter:_______________________________ Date, Time and Venue: _________________________________
Level and Group: ________________________________
General Objective: At the end of 40 minutes, the students of N102 Group 3 will be able to accurately discuss the individual topics assigned,
related to Postpartum Psychosis
Specific Objectives
Description ContentTime
AllotmentReference Evaluation
Teacher Student