Puerperal or postpartum psychosis: causes, symptoms and treatment

One out of every 1000 women who have a baby suffers a psychotic crisis shortly after childbirth.

Rarely do symptoms of psychosis appear in women in the period immediately following childbirth. Although psychiatric manuals do not list puerperal psychosis as a specific disorder, many professionals use this concept to refer to such situations.

In this article we will discuss the main symptoms and causes of puerperal psychosis, as well as other basic characteristics of puerperal psychosis.as well as some of its other basic characteristics. We will also briefly review the therapeutic options currently available to manage this problem.

What is puerperal psychosis?

Puerperal or postpartum psychosis is a type of psychotic disorder that appears in women who have just had a baby, usually in the two weeks following childbirth. It is characterized by typical symptoms of psychosis such as hallucinations, delusions, disorganized thinking, behavioral disinhibition, and disorganization of thought.It is characterized by typical symptoms of psychosis such as hallucinations, delusions, disorganized thinking, behavioral disinhibition and catatonia.

In psychotic disorders there is a loss of contact with reality which can manifest itself in different areas and is of varying severity. It is believed that there is a strong genetic influence that determines the development of symptoms of psychosis.

This form of psychosis was described by the German obstetrician Friedrich Benjamin Osiander in 1797. In the past, puerperal psychosis was attributed to infections, Thyroid disorders or eclampsia, a convulsive disorder of pregnancy; although these hypotheses have been discarded (except thyroid), the causes remain unclear.

It is a relatively rare disorder, since it affects 1 in every 1000 women who give birth. affects 1 in 1,000 women who give birth.. In comparison, postpartum depression, a subtype of major depressive disorder, occurs in approximately 15% of mothers. Although psychotic symptoms may occur in the setting of postpartum depression, they are distinct disorders.

The DSM manuals do not include the diagnosis of puerperal psychosis; using these guidelines, these cases should be classified as "Psychotic disorders not otherwise specified". In ICD-10 we find the category "Mental and behavioral disorders in the puerperium", which also includes postpartum depression.

Common symptoms and signs

The reported symptoms and observable signs of puerperal psychosis vary greatly from case to case, and even throughout the course of the disorder in the same person. Opposing symptoms, such as euphoria and depressive state, sometimes occur together.

The most common initial signs of postpartum psychosis include the onset of feelings of euphoria and depression. include the appearance of feelings of euphoria, reduction in the amount of sleep, mental confusion and verbosity.

In addition to being classifiable as a psychotic-type condition similar in nature to schizophrenia or schizoaffective disorder, the usual symptoms of puerperal psychosis sometimes also resemble those of schizophrenia or schizoaffective disorder. also resemble those of mania and depression.the main mood disorders.

• Delusions and other strange beliefs
• Hallucinations, especially auditory
• Paranoia and suspiciousness
• Irritability and emotional instability
• Low mood, even depressed
• Mania: feeling of euphoria, increased energy and psychological agitation
• Racing thoughts and severe confusion
• Communication difficulties
• Motor hyperactivity and behavioral disinhibition
• Decreased need for or ability to sleep
• Lack of recognition of disturbances
• Increased risk of suicide and infanticide

Causes and risk factors

Research shows that puerperal psychosis is associated with schizophrenia. associated with schizophrenia, bipolar disorder and schizoaffective disorderAbout one third of women with these disorders suffer severe psychotic episodes after childbirth. In addition, people with postpartum psychosis have a 30% chance of having another episode in subsequent pregnancies.

It is believed that there is a genetic component to this disorder, since the fact that a close relative has been diagnosed with puerperal psychosis increases the risk of developing it by approximately 3%. Family history of depression in pregnancy or postpartum, psychotic-affective disorders and thyroid dysfunction are also risk factors.

However, half of the women who suffer from puerperal psychosis do not present any risk factors; one hypothesis that could explain this would be the one that associates this disorder to hormonal and sleep cycle changes. hormonal and sleep cycle changes that occur after childbirth.. New mothers seem to have a higher probability of developing this type of psychosis.

Treatment of postpartum psychosis

When a case of postpartum psychosis is detected, it is most common for the hospital stay to be prolonged or for the mother to be hospitalized again. In general, the management of this disorder is carried out by means of pharmacotherapy, although there are emergency psychological intervention programs for psychosis that can be very useful as a complement.

Among the medications used to treat this disorder, two categories stand out: antipsychotics and mood stabilizers.These are the reference psychotropic drugs in bipolar disorder. Antidepressants can also be useful in managing symptoms such as depressed mood, irritability, sleeping difficulties and cognitive problems.

Cases resistant to pharmacological treatment that are also severe, such as those with a manifest risk of suicide, are sometimes treated with electroconvulsive therapy.

Most people who suffer from this disorder recover fully within six months to a year, while the severity of symptoms usually decreases markedly within three months after delivery. The risk of suicide remains high during the recovery period..