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puerperal psychosis; postpartum psychosis, puerperal bipolar disorder
Etiology:
- episode of bipolar affective disorder (may be 1st) [2]
Epidemiology:
- 1 or 2 of 1000 mothers, generally in the 1st 2 weeks postpartum
Clinical manifestations:
- sudden onset of psychotic symptoms following childbirth
- manic & depressive forms
- manic & acute polymorphic forms almost always start within the first 14 days after childbirth, but depressive psychosis maydevelop later
- signs/symptoms
- hallucinations
- delusions
- illogical thoughts
- insomnia
- anorexia or refusing to eat
- anxiety &/or agitation
- periods of delirium or mania
- suicidal or filicidal thoughts
Complications:
- suicide is rare
- infanticide extremely rare
Management:
- psychiatric emergency requiring hospitalization through secure transfer
- see bipolar disorder
- lithium carbonate
- antipsychotics: haloperidol has been used
- antidepressants
- psychological counseling & support group therapy
- electroconvulsive therapy is effective
General
psychosis
complications of the puerperium
References
- Wikipedia: Postpartum psychosis
http://en.wikipedia.org/wiki/Postpartum_psychosis
- Munk-Olsen T et al.
Psychiatric disorders with postpartum onset: Possible
early manifestations of bipolar affective disorders.
Arch Gen Psychiatry 2012 Apr; 69:428.
PMID: 22147807
- Pregnancy-info.net: Postpartum depression
http://www.pregnancy-info.net/postpartum_psychosis.html
- NEJM Knowledge+
- Osborne LM.
Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers.
Obstet Gynecol Clin North Am. 2018 Sep;45(3):455-468.
PMID: 30092921 PMCID: PMC6174883 Free PMC article. Review.
- Bergink V, Rasgon N, Wisner KL.
Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood.
Am J Psychiatry. 2016 Dec 1;173(12):1179-1188.
PMID: 27609245 Review.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16040454