Postpartum psychosis is an acute mental disorder that develops in the first weeks after childbirth. It is manifested by depression, insomnia, confusion, delusional ideas about the incurable disease of the child, delusions of persecution, hallucinations. The behavior of the patients becomes inadequate: they refuse to take care of the newborn, harm him, commit suicide attempts. The diagnosis is carried out by a psychiatrist, the main methods are clinical conversation and observation. Medication treatment, neuroleptics, antidepressants, tranquilizers are used. When the condition improves, psychotherapy sessions and family counseling are introduced.
F53.1 Severe mental and behavioral disorders associated with the postpartum period
Postpartum psychosis is also called postnatal. This disorder was first described by Hippocrates in 460 BC. Its origin was explained by large blood loss during childbirth. More accurate studies date back to the middle of the XIX century. French psychiatrists J.-E. Esquirol and L.-V. Marse described the psychoses of young mothers as the consequences of severe somatic complications of childbirth. Currently, the prevalence of psychotic disorders has significantly decreased. In economically developed countries, their frequency is 1-1.2 cases per 1,000 women who gave birth no more than 3 months ago. The peak of morbidity is observed during the first 30 days after the birth of a child.
Official data confirm that more than half of women with postnatal psychosis have mental disorders (schizophrenia, depression, MDP) or a hereditary predisposition to them. The exact causes of the pathology are unknown, but several groups of triggers have been identified – factors contributing to its debut:
- Complications of pregnancy, childbirth. Acute psychotic state is often caused by the death of a newborn, premature birth, and the threat of miscarriage. The connection of the disorder with massive blood loss and sepsis revealed in ancient times is confirmed.
- Hormonal disorders. Termination of pregnancy is always associated with a change in the level of hormones in a woman’s body. Mental disorders develop on the basis of a sharp decrease in the synthesis of progesterone, estrogens, thyroxine.
- Defeat of the central nervous system. Psychosis occurs more often in neurological diseases, after brain injuries, neuroinfections, intoxication. Sometimes the disorder is provoked by the use of scopolamine in combination with lidol for pain relief in childbirth.
- Anxiety-hypochondriac personality traits. Women with high emotional tension, low adaptive abilities, a tendency to predict failures are more prone to depression and the formation of delusional ideas. The process of childbirth becomes a stressful situation for them, triggering a mental disorder.
- Unfavorable psychosocial situation. Risk factors are unwanted pregnancy, rejection of the child by the mother, financial difficulties, unsettled life, divorce from a spouse. Psychoses are often diagnosed in women in labor who lead an antisocial lifestyle (drug addiction, alcoholism, prostitution).
According to the mechanism of origin, postpartum psychosis is reactive. It develops in response to a traumatic event – childbirth. It is based on the experience of fear of death, violation of the integrity of one’s own personality, restriction of freedom, lack of love of others (shifting attention from a woman to a child). An unfavorable background for the occurrence of psychosis is psychophysiological asthenization – depletion of energy, decreased resistance to stress factors. There comes a state of decompensation of nervous adaptive mechanisms.
At the neurophysiological level, there is a violation of reciprocal inhibitory interactions between the cortex and subcortical brain structures, between the anterior and posterior hypothalamus – the highest centers of regulation of autonomic functions and emotions. The balance of activation of the sympathetic and parasympathetic nervous systems, the ratio of the main neurotransmitters (serotonin, norepinephrine, dopamine, GABA) changes. According to psychodynamic theory, postpartum psychosis results from a conflict between the mother’s real desires and the situation of motherhood.
Symptoms of postpartum psychosis
Psychosis begins to manifest itself 2-3 days after the completion of childbirth, when a woman realizes the changes that have occurred in her life. Symptoms may develop gradually or rapidly. Initially, there is insomnia, anxiety, anxiety, fatigue, fatigue. The emotional background is steadily reduced. Then suspicion and alertness begin to grow. Super-valuable ideas are formed about the state of the child’s health, about the presence of diseases in him or herself. Consciousness becomes confused, speech becomes abrupt, illogical.
Suspicion is constantly increasing. Often mothers closely monitor the newborn during sleep and feeding, examine him, listen to his breathing and heartbeat, identifying imaginary incurable, fatal diseases. Patients begin to accuse doctors and close relatives of indifference to the condition of the baby, of deliberate unwillingness to treat him. Secretly from others, they give him various medications, carry out “procedures” that can cause real harm (they dip him in cold water, leave him without clothes and diapers).
In another variant of the course of psychosis, mothers lose interest in babies, do not show care and love. Excessive guardianship turns into a feeling of hatred. Delusional thoughts are expressed about the substitution of a child, the introduction of evil spirits, demons into him, about the imminent inevitable death. In severe cases, auditory hallucinations are noted. Voices call on women to kill the newborn, attempts are often made to strangle him. Throughout the disease, patients’ criticism of their condition is violated – delusions and hallucinations are not realized, are not regarded as pathological.
Without timely diagnosis and treatment, postpartum psychosis poses a danger to the life and health of the infant and mother. On the basis of hallucinations and delusions, inappropriate behavior is formed – patients try to commit suicide, having previously killed the baby. There are cases of suffocation, falling from a height of a woman and a newborn. With a sluggish psychotic process, when indifference and detachment gradually increase, the child does not receive sufficient emotional and sensory stimulation, lags behind in physical and mental development, suffers from neurotic disorders from an early age (enuresis, nightmares, phobias).
Postpartum psychosis manifests itself with classic signs of acute psychopathology, so making an accurate diagnosis can be difficult. Relatives of the patient play an important role in the process of detecting the disease, they are the ones who most often pay attention to changes in the behavior and emotional reactions of a young mother. Professional diagnosis is performed by a psychiatrist, in addition, it may be necessary to conduct a pathopsychological, gynecological and neurological examination in order to differentiate postnatal psychosis with schizophrenia, bipolar affective disorder, depression, hypothyroidism, Cushing’s syndrome. Specific diagnostic methods include:
- Collecting anamnesis. The doctor examines the medical documentation on the course of childbirth and pregnancy, finds out the presence of hereditary burden on mental disorders, the available psychiatric diagnoses of the patient, postpartum depression, psychosis after previous pregnancies. The material and living conditions of life, the presence of a spouse, the patient’s attitude to conception, pregnancy, and the birth of a child are taken into account.
- Clinical conversation. In direct communication with the patient, the psychiatrist evaluates the productivity of contact, the purposefulness of thinking and speech, the logic of reasoning. With a psychotic disorder, women express delusional ideas in detail, focus on their own experiences, and do not always answer in accordance with the specialist’s questions.
- Observation. During the conversation, the doctor observes behavior and emotions, determines their adequacy, the safety of arbitrary control, motivation. Psychosis is characterized by alertness and distrust, inconsistency of reactions to the examination situation, predominance of dysphoric and / or depressive affect, lack of critical attitude to one’s behavior.
Treatment of postpartum psychosis
Acute condition therapy is carried out in a hospital setting. Women are often sent to psychiatric departments and neuropsychiatric dispensaries from the maternity hospital. During intensive treatment, the child is separated from the mother, entrusting care to close relatives. Comprehensive assistance includes the following areas:
- Pharmacotherapy. At the acute stage of the disorder, the main task is to relieve psychotic symptoms. Neuroleptics, normotimics, tranquilizers, antidepressants are prescribed. For the period of taking medications, it is necessary to exclude breastfeeding by selecting artificial mixtures for nutrition for the child.
- Psychotherapy. After the symptoms of psychosis are eliminated, there comes a period of awareness of the patient of her actions, feelings, and the presence of the disease. This provokes depression, guilt and self-hatred. To stabilize the emotional state and correct negative attitudes, techniques of cognitive-behavioral direction, psychoanalysis are used.
- Family care and rehabilitation. The support of loved ones and the correct organization of the daily routine is important. Relatives organize round-the-clock monitoring of the patient, perform procedures for caring for the baby together with the mother. It is important to spend time with a young mother, talk, distract from painful thoughts, monitor the regular intake of medications prescribed by a psychiatrist.
Prognosis and prevention
Postpartum psychosis has a favorable outcome, provided that depression is successfully overcome, support from close people, and there are no mental illnesses. Prevention is based on proper physical and psychological preparation of a woman for pregnancy and childbirth. Expectant mothers need to pay attention to planning in order to minimize the risk of complications. It is recommended to attend courses on child care skills, master breathing techniques and relaxation during childbirth, share your experiences with your husband, parents, close friends, and if there is a pronounced anxiety, seek help from a psychologist.