Postnatal Psychosis
(Postpartum Psychosis or Puerperal Psychosis)

Fortunately Postnatal Psychosis (also known as Postpartum Psychosis or Puerperal Psychosis) is a much rarer condition than Postnatal Depression, for example, occurring in only about 1 - 2 out of a 1,000 women following childbirth. However, it is a very severe mental illness, is considered a medical emergency, and requires immediate professional attention. Admission to a psychiatric hospital is commonly required, and it may take a few weeks to recover. The symptoms of Postnatal Psychosis can occur at any time during the first 3 months after giving birth, although most commonly the onset is around 2 - 3 weeks Postpartum. The symptoms usually occur suddenly, dramatically and unpredictably, and the patient may go from being completely normal one minute, to exhibiting severe psychotic symptoms the next. The disorder is most common amongst first time mothers, and essentially the woman cannot distinguish fantasy from reality. Despite often being delusional, many patients are aware that things are not right, but unfortunately due to the stigma of mental illness, many do not consult health care providers for the attention they so urgently need. These episodes can be frightening and disorienting for the woman concerned, and also for those around them.

Postnatal Psychosis can involve many different mood symptoms, although each case is unique. Erratic behaviour is very common. The sufferer may swing from being elated one moment, to being profoundly depressed the next. As well as behaving strangely, hallucinations and delusions are common. Sleeping poorly, being restless, and feeling confused and irritable are amongst the other symptoms frequently experienced. Suicide is rare, but can occur in up to 5% of sufferers in the absence of treatment. It is largely because of the delusional thinking and irrationality that women need to be carefully monitored and treated by appropriate health care professionals during their illness. Postnatal Psychosis is thought to be closely linked with bipolar disorder, and a woman is at considerably greater risk if she already has this condition, or indeed any history of previous psychotic symptoms including schizophrenia. Similarly, having a family history of any of these disorders makes Postnatal Psychosis more likely to occur, so there is a significant hereditary factor. If any of this applies to you, it is important to make this clear to your healthcare providers to alert them during your pregnancy. A previous episode of Postnatal Psychosis makes it up to 50% more likely that the condition will recur following subsequent pregnancies.

Experts cannot be certain as to the exact causes of Postnatal Psychosis. However, in addition to the heritability factors mentioned above, the woman's hormonal changes after childbirth are thought to play a significant part. For example, the sudden dramatic drop in progesterone and oestrogen following delivery can be a trigger. Disrupted sleep patterns may also contribute to the condition's severity. Other risk factors include lack of social support, low self-esteem, feelings of isolation, and any major life changes, and of course - having a baby is in itself a major life change.

Early recognition and treatment of the condition can significantly improve the speed of recovery from Postnatal Psychosis. It is important to realise that this is a temporary condition, and with the right professional help you should respond well and recover. Indeed, more than 90% of women make a full recovery so the outlook is very positive. Recognise that you are not to blame for your illness, and be upfront with your GP, midwife or health visitor if you are suffering any of the symptoms mentioned in the next section, or if any of the above applies to you. To re-iterate, it is extremely important to seek help, or that a partner or other close relative obtains the medical attention you require if you feel unable to speak for yourself. Hospitalisation for a few weeks may well be necessary, partly for your own safety, but in many parts of the country there are mother and baby units so you need not necessarily be separated from your baby. In less severe cases, treatment can take place at home, provided there is family support available at all times, as well as professional input. Treatment usually involves medications such as anti-psychotics, antidepressants and/or anti-anxiety drugs. Psychological counselling can also be beneficial as can support groups (please see Interventions section). Remember above all, whilst Postnatal Psychosis can be very distressing at the time, this is a treatable condition.

Symptoms

  • delusions or strange beliefs (often related to the baby)
  • hallucinations (such as hearing or seeing things that aren't there)
  • extreme mood swings (e.g. fluctuating between elation and severe depression)
  • disorientation
  • illogical thoughts
  • disorganised behaviour
  • extreme anxiety and agitation
  • irritability
  • hyperactivity and restlessness
  • puzzlement and perplexity
  • inability to sleep
  • paranoia or suspiciousness
  • difficulties communicating, or fast erratic speech
  • suicidal thoughts
  • worsening marital and family relationships

Diagnosis

If you recognise any of the above symptoms, it is vital to seek immediate medical attention. Consult your health visitor, midwife or GP who will almost certainly refer you to your local mental health team for an assessment by a Psychiatrist. This will be done without delay. Do not be put off by the stigma often associated with mental illness, and remember you are not to blame for your condition. Nor does it mean that you are a bad mother - you are simply ill. If you find it difficult asking for help, perhaps ask your partner or a close relative to accompany you for assessment, particularly as they may have additional insight into your current condition which you are not fully aware of yourself. If it is confirmed that you do have Postnatal Psychosis, the appropriate medication and likely admission to a psychiatric unit can mean the difference between life and death. You will then access the vital treatment you need to recover.

Medication, Hospitalisation and Community Treatment

With the correct medication, Postnatal Psychosis can usually resolve within a matter of a few weeks. As noted in the introduction, the recovery rate is over 90% with treatment. Antipsychotic drugs such as Olanzapine or Amisulpride can help with over-activity and delusions. It may take a while to find the right drug and the correct dosage because each patient is different. Lithium, which is a mood stabilising drug, is often used to help with the mood swings which patients are prone to, and some researchers believe this drug may actually help prevent the occurrence of Postnatal Psychosis in at-risk groups. Additionally, benzodiazepines may be used to reduce anxiety. Electro-convulsive therapy can be rapidly effective, but will not necessarily be the first treatment of choice.

Often the sufferer will be hospitalised until the symptoms of Postnatal Psychosis are significantly reduced, and whilst assessment and treatment are taking place. This may take a few weeks, but is necessary in some cases to ensure the wellbeing of both mother and child. As mentioned in the introduction, there are some mother and baby units in the country so that the two do not necessarily need to be separated. Support will be provided to help the mother-infant relationship to develop along healthy lines. The involvement of the partner in treatment, if there is one, will also be encouraged. If the sufferer is hospitalised, then on discharge, a multi-disciplinary team are likely to be involved to ensure the healthy development of both mother and child. Aims include easing the transition from hospital back into the community, and helping to prepare the mother for her new role with her baby so that normal family life can resume.

People with only moderate Postnatal Psychosis may be able to be treated within the home provided there is a partner or close relative available at all times, and that visits by professional staff are frequent. Compliance with treatment will be vital. Practical arrangements may be set up to help with the childcare, again often involving professionals, although close family members can play a vital role here too.

Counselling and Support Groups

It is very important to realise that you are not alone in suffering Postnatal Psychosis. Psychological counselling can help you to overcome your false beliefs, and set you on the road to recovery. That is one possible route, and if you are interested, it is worth talking to your GP or health visitor about this. There is also a charity called Action on Postpartum Psychosis (APP) which works to raise awareness of the illness, to tackle the associated stigma, and to support those who feel isolated. It is a network of women who have themselves suffered, and who have teamed up with academic experts to provide up-to-date information on the condition, as well as to encourage peer support. The latter may be invaluable, as sharing stories with other sufferers can be immensely beneficial to the individual. Please see: www.app-network.org to see how they may be able to help you.