Recognizing postpartum psychosis and treatment direction

Postpartum psychosis is often associated with hormonal changes, family history, genetics, and trauma. Treatment will depend entirely on the type of mental disorder and individual response.

postpartum psychosis

Psychiatric disorders are common during pregnancy and postpartum due to physiological changes

What is postpartum psychosis?

Mental disorder is a term that refers to all unusual problems related to mental health. In the past, mental illnesses have not received as much attention as they are now due to their low prevalence and not much research. Currently, mental disorders have received more attention – especially in special populations such as pregnant and postpartum women.

Postpartum psychosis was first mentioned by the physician Hippocrates but went unnoticed. It was not until the 1700s – 1800s that this pathology was mentioned in French and German literature. Research into postpartum psychosis takes a long time and is controversial. Fortunately, pregnant women can now take care of their health in a comprehensive way thanks to the development of medicine.

Experts say, the first 3 months after giving birth is a period of susceptibility to mental disorders. At this time, the state of the mother has not fully recovered, so the resistance to stress is very poor. Without the emotional support from the family and the constant lashing out, psychological damage is inevitable.

Postpartum mental disorders and how to recognize them

Postpartum psychosis is divided into three main categories: Baby Blues (Postpartum Blue), Nonpsychotic Postpartum Depression, and Puerperal Psychosis. These diseases have similar symptoms, so it is easy to confuse them.

Equipping knowledge about postpartum psychosis will help patients and their families promptly detect and treat them early. In fact, symptoms will also vary from case to case and how long the disease has progressed.

Common postpartum mental disorders and how to recognize them:

1. Baby Blues syndrome

Baby Blues syndrome is one of the common psychological problems in postpartum mothers. This syndrome occurs in 30-85% of women and most of the symptoms start within the first week. Typical symptoms of Baby Blues syndrome are anxiety, insomnia, irritability and strong emotional fluctuations.

postpartum psychosis

Baby Blues syndrome is a mild postpartum psychosis and is not cause for concern

Symptoms of Baby Blues Syndrome:

  • Emotional instability, irritability and anger
  • Concerned about the health and future of the newborn
  • Excessive preoccupation with appearance and body
  • Feelings of ambiguity, becoming closed and less communicative

Baby Blues syndrome is associated with hormonal disturbances and difficulties adjusting to new roles. This syndrome is quite mild and most of them are relieved after a short time. However, there are also cases where the condition persists, then develops into other postpartum psychosis.

2. Postpartum depression

Postpartum depression is one of the most common postpartum mental disorders with an incidence of 10-15%. Unlike Baby Blues syndrome, depression has a slow progression and mild symptoms in the early stages. Symptoms of the disease begin in the first 2-3 months after giving birth and worsen over time. Characteristic manifestations of the disease are low mood, depression, insomnia and excessive anxiety.

postpartum psychosis

Postpartum depression is a common form of postpartum psychosis with an incidence of 10-15%.

Typical signs of postpartum depression:

  • Sad mood, face clearly showing melancholy and suffering
  • Pessimistic, negative about the future
  • Excessive worry about the health of yourself and the child
  • A complete loss of positive emotions even when life is extremely favorable and full of joy.
  • In the long run, the patient loses all joy and interest in life.
  • In addition to mood abnormalities, postpartum depression also has a number of other manifestations such as slow walking, sedentary, habit of lying or sitting still for many hours, low voice, whispering, thinking. only slow…
  • Postpartum depression is also characterized by physical symptoms such as insomnia, loss of appetite, fatigue, headaches, etc.

The causes of postpartum depression are much more complicated than Baby Blues. The disease has a persistent and chronic progression, easy to recur in the next birth. Depression needs to be treated early to prevent complications – especially suicidal behavior, self-destructive behaviors, and babies.

3. Postpartum psychosis

Postpartum psychosis is a severe form of postpartum psychosis with an incidence of 0.1 to 0.2%. This pathology is characterized by a sudden onset, easy to recognize and usually appears in the first 2-4 weeks after birth. Postpartum psychosis has diverse symptoms, widespread onset, and easy recognition.

Signs of postpartum psychosis:

  • Presence of delusions, hallucinations, hallucinations and other hallucinations – often appearing in the form of dreams. The content of hallucinations and delusions often related to childbirth such as delusions of harm (the child will be abducted, assassinated, murdered), delusional denial (denial of the child’s gender, does not acknowledge the child’s birth and completely denies the child’s existence).
  • Mood is unstable, often ranging from stupor and fatigue to mania and excitement. During the mixed phase, the patient may become overly anxious.
  • Some people become agitated and aggressive, driven by hallucinations and paranoia.
  • Depersonalization (feeling detached from surroundings or having a sense of detachment from one’s own mind, body, emotions)
  • Disorganized behavior (exciting, weird behavior, some people acting childish, not practicing personal hygiene and not paying attention to appearance)

Before the onset of psychosis, there will often be manifestations of Baby Blues syndrome or sleep disturbance in the form of nightmares, agitation at night. Compared with depression, the rate of psychosis in postpartum women is lower but more dangerous and the recurrence rate is higher.

Causes of postpartum psychosis

Pregnancy and childbirth are sensitive periods with marked physiological changes. Experts believe that psychological damage begins during pregnancy, then develops into postpartum psychosis. The risk is increased if you are dealing with trauma and difficulties in the postpartum period.

The exact cause of postpartum psychosis remains unknown. However, experts support the theory that the disease is the result of hormonal changes, genetic factors and psychosocial factors.

Causes and factors that cause postpartum psychosis:

1. History of mental disorder

Most women with postpartum psychosis have a history of the disease. Experts found that the recurrence rate of postpartum depression is 50% and postpartum psychosis is 70%. In addition, the risk is also increased in those who experience psychiatric disorders during pregnancy.

2. Hormonal disorders

Postpartum hormone disturbances play an important role in the pathogenesis of postpartum psychosis. After 48 hours of delivery, the hormones estrogen and progesterone drop sharply to facilitate the production of the hormone prolactin. These changes will inadvertently facilitate the development of mental disorders.

postpartum psychosis

Hormonal changes in the postpartum period are factors that increase the risk of psychosis

  • Progesterone: A drop in progesterone after delivery is thought to be associated with psychiatric disorders. Because many studies show that supplementing with this hormone can reduce marked emotional abnormalities. However, some studies have not found a significant difference between the levels of the hormone progesterone in postpartum and non-depressed women.
  • Estrogen: Low estrogen levels after childbirth are favorable conditions that increase the risk of postpartum depression and Baby Blues syndrome. However, this is not enough to draw concrete conclusions because the difference between women with mental disorders and healthy women is not significant. However, the drop in estrogen will also affect the levels of serotonin and other neurotransmitters in the brain.
  • Cortisol: Cortisol levels rise sharply in late pregnancy and peak during delivery. Immediately after giving birth, the hormone drops suddenly and returns to normal levels by the next month. Sudden hormonal changes are thought to increase the risk of postpartum psychosis.
  • Thyroid hormones: In addition to the above hormones, thyroid hormones also change after giving birth. Specifically, thyroxine levels drop significantly during pregnancy and postpartum. A drop in this hormone, along with several other hormones, is a risk factor for postpartum psychosis.

3. Some other causes and factors

In addition to the causes mentioned, postpartum psychosis is also associated with the following factors:

  • Family history
  • Facing obstetric complications such as stillbirth, caesarean section, etc.
  • Pregnancy at a young age, not financially and psychologically prepared
  • History of alcoholism, drug addiction, etc.

Is postpartum psychosis dangerous?

Postpartum psychosis affects not only the pregnant woman directly, but also the newborn and other family members. The level of danger will depend on the type of mental disorder, specific symptoms, time to progression, and response to treatment.

The effects of postpartum psychosis:

  • Newborns are not well taken care of because the mother herself is inhibited emotionally, thinking or being dominated by paranoia, hallucinations
  • May commit suicide and kill the child
  • Increasing conflict in relationships
  • Increase the burden on the family, especially mentally and financially
  • Increased risk of psychiatric disorders in subsequent births
  • Increase the rate of using alcohol, drugs, tobacco, etc.

The symptoms of postpartum psychosis cause significant distress to family members. If the family does not understand, it is likely that conflicts and conflicts will inevitably arise. This is the premise for the rift in marriage, cold family life, lack of laughter.

Diagnosis of postpartum psychosis

Postpartum psychosis is diagnosed based on clinical presentation. In addition, the doctor will also rely on a number of factors such as family history, pathology to assess the extent of the disease and make a prognosis.

Diagnostic techniques for postpartum psychosis:

  • Clinical diagnosis
  • Paraclinical tests
  • Psychological test

For psychotic cases, the doctor will rely on physical symptoms to order some more in-depth tests to rule out possible possibilities. In particular, it is necessary to rule out physical causes such as hypothyroidism, vitamin B12 deficiency, ganglioside disease, and side effects of certain medications.

Treatments for postpartum psychosis

Treatment for postpartum psychosis depends entirely on the specific type of psychosis. In addition, the regimen will also be individualized according to the severity of symptoms and response capacity of each case.

Treatment options for postpartum psychosis:

1. Baby Blues Syndrome

Baby Blues syndrome usually has mild symptoms and resolves on its own without treatment. To avoid long-term effects, the family needs emotional support so that the postpartum woman quickly adapts to her new role. In addition, the family should also support in taking care of the child so that the mother herself has time to rest and take care of herself.

postpartum psychosis

Family support will help postpartum women overcome Baby Blues syndrome

In general, Baby Blues syndrome is not cause for concern. After about 7-10 days, the symptoms will gradually subside, the mother after giving birth can adapt to the changes in life and fulfill her role as a mother.

However, if Baby Blues syndrome persists for more than 2 weeks, families should encourage postpartum women to visit for a more thorough evaluation. Timely examination will help detect abnormal signs, thereby having a timely treatment plan to prevent complications.

2. Postpartum depression

Postpartum depression requires long-term treatment to control and prevent recurrence. At the time after delivery, the optimal solution is non-drug measures to avoid affecting breast milk. However, if the patient has suicidal thoughts and behaviors, medication should be considered because the benefits outweigh the risks.

Treatments for postpartum depression:

  • Psychotherapy: Psychotherapy is the preferred method in the treatment of postpartum psychosis. In particular, self-centered therapy is the most effective method today. This method focuses on the relationship between the patient and her husband and children, thereby building a close relationship between family members. Awareness of her own role with the family will help the patient to be motivated to fulfill the role of mother.
  • Medications: The preferred treatment options for postpartum depression are Venlafaxine, Sertraline, and Fluoxetin. These drugs are well tolerated and have few side effects. Severe cases of agitation and panic will be combined with a benzodiazepine sedative (Lorazepam, Alprazolam).
  • Electric shock (ECT): In case of severe depression with high risk of suicide, electric shock (ECT) is indicated. This method is safe for postpartum women and brings high treatment efficiency. For severe cases of depression, doctors will often request inpatient treatment to ensure safety and minimize unfortunate situations.

Treatment of postpartum depression must be carried out on a long-term basis to prevent recurrence. Therefore, the family needs to pay attention to the symptoms after treatment to detect recurrence early. In fact, many patients pretend to be cured to easily commit suicide.

3. Postpartum psychosis

Postpartum psychosis is a psychiatric emergency that requires hospitalization as soon as possible. Because the rate of patients who commit suicide is up to 4% – a not small number and especially the risk of suicide in this case is very high.

Treatments for postpartum psychosis:

  • Antipsychotic drugs
  • Mood stabilizers
  • Electroconvulsive therapy (ECT)

Electroconvulsive therapy is the preferred method because of its rapid effectiveness, good tolerability, and few side effects. The use of the drug will be carefully considered to minimize the risk to the mother and the newborn. Although controversial, it is clear that antipsychotics and mood regulators have an important role in preventing suicidal behavior, harming babies.

Prevention of postpartum psychosis

Postpartum mental disorders affect the health of mothers and babies. Therefore, it is advisable to proactively take preventive measures, especially in the case of a history of mental disorders and a family history of the disease.

postpartum psychosis

A healthy and happy living environment will help women after giving birth to avoid psychological and mental problems

Methods to prevent postpartum psychosis:

  • For cases with a history of postpartum psychosis, doctors will prescribe Lithium at 36 weeks or within 48 hours of birth. This measure can minimize the recurrence rate, and at the same time reduce the severity and duration of the disease.
  • Join antenatal courses to prepare for psychophysiology and knowledge of child care. This will help you quickly adapt to your new role and learn to balance your emotions.
  • Families need to try to build a healthy living environment to support the mother’s spirit after giving birth. Minimize stress factors, especially those facing obstetric complications.
  • Those at high risk of postpartum psychosis (history of postpartum depression, recurrent major depression, depression during pregnancy, history of postpartum psychosis, history of bipolar disorder, etc.) You should notify your doctor for advice on how to prevent it.

Postpartum psychosis is an issue that needs more attention, especially in the context of an increased rate of mothers with self-harm and suicide behaviors. Currently, there is still no method of complete prevention, but the care and emotional support from the family will greatly help in preventing and reducing the severity of the disease.

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