Women at Risk for Postpartum Psychosis Need Close Monitoring
Postpartum Psychosis Basics
Postpartum psychosis is a rare event that appears in only one or two of every 1,000 U.S. women who give birth. The condition gets its name because it produces symptoms of psychosis, a mental state characterized by a substantial loss of the ability to stay oriented to reality. In any given woman affected by PPP, psychosis symptoms typically center on various forms of delusional thinking; mental health professionals use this term to describe deeply held thoughts or thought patterns that defy logic or known facts and make no sense to other people. Specific forms of these patterns found in association with postpartum psychosis include “bizarre” delusional thoughts, egotistical or grandiose delusional thoughts and paranoid delusional thoughts. Other common PPP symptoms include auditory (sound-based) hallucinations, disorganized or disrupted thinking, unusually disorganized or disruptive behaviors and prominent, unusual fluctuations in general mood.
Some affected women develop postpartum psychosis as soon as two or three days after they give birth; others develop symptoms of the condition within a timeframe of one week to one month or longer. PPP is heavily associated with the presence of bipolar disorder, and fully 72 to 88 percent of women who develop the condition shortly after giving birth have either bipolar disorder or a schizophrenia-related illness called schizoaffective disorder, the authors of a 2006 study review in the Journal of Women’s Health report. Other known risk factors for the onset of postpartum psychosis include genetic inheritance, pregnancy complications, hormone fluctuations that occur in the aftermath of giving birth, stress from a woman’s postpartum personal and social environment, and an ongoing lack of sleep.
The most serious potential consequence of postpartum psychosis is the onset of a recurring preoccupation with harming one’s self or harming one’s newborn child. The inability to accurately distinguish reality from delusions and/or hallucinations deepens the severity of this preoccupation and sharply increases the chances that an affected mother will actually attempt to hurt herself or kill her newborn child. It is the potential for suicide and infanticide that makes postpartum psychosis such a serious health risk, and doctors provide treatment as soon as possible for identified cases of the condition. As a rule, PPP treatment requires some form of hospitalization.
Need for Monitoring
In the study review published in The Obstetrician & Gynaecologist, a team of Welsh researchers examined previous research findings regarding postpartum depression and subsequently made several important recommendations. First, they recommend that all women with known risks for developing PPP receive counseling before they get pregnant; receive appropriate medical care before, during and after pregnancy; and undergo especially close monitoring for the presence of psychosis-related symptoms in the days, weeks and months following childbirth. In addition, they recommend that all women without known risk factors for postpartum psychosis receive screening for the condition in the period following the birth of a child.
Critically, the authors of the review also recommend that both OB/GYN specialists and mental health professionals continue to monitor the psychological wellbeing of all new mothers for at least three months after childbirth. This recommendation holds true for women who have no PPP risk factors and show no signs of the condition in the first weeks of postpartum recovery. Finally, the review’s authors recommend that women and their doctors create an advance plan for dealing with the possibility of postpartum psychosis before or during the initial phases of pregnancy.
Roughly 75 to 80 percent of PPP-affected women with bipolar disorder experience only one bout of psychosis and recover their mental wellbeing, the authors of the review in the Journal of Women’s Health note. Roughly 50 of all PPP-affected women with a schizophrenia-related illness also recover after a single bout of psychosis. When they receive appropriate care, women with early-onset postpartum psychosis generally experience fewer long-term mental health complications than women who only develop PPP a month or more after childbirth.