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: y y y y y y y y y y y y y 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 arent exactly sure why postpartum psychosis happens. However, they do offer a variety of explanations for the disorder, with a womans 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 womans 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 manicdepressive 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.
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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.
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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:_______________________________ Level and Group: ________________________________ Date, Time and Venue: _________________________________

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
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