Postnatal Psychosis

 by Mia Parry

(image: NCT)

Postnatal psychiatric conditions are an anomalous but highly dangerous outcome from a pregnancy, however, less than 5% of pregnant women consider this before birth. Most commonly, depression comes to mind when thinking of postpartum illnesses, with OCD, psychosis and schizophrenia at the foreground. So what is postnatal psychosis? How can it be treated? and what needs to be done to generate awareness?

Postnatal psychosis is a dangerous and unpredictable condition, developing after the birth of a child, a time at which a lady’s mental health will be at its most fragile state. There are many different illnesses, including OCD, affecting 2% of mothers in some form during pregnancy and 3% after, depression, affecting 1 in 10, with 80% experiencing the ‘baby blues’ and finally postnatal psychosis, affecting 1 in every 1000 women. It will be this more obscure and rare condition of which I will focus on. Unfortunately it is complex and varied so the causes are largely unknown. However, massive hormonal changes following childbirth, along with fatigue, a family history of mental health, the momentous change a baby brings and a traumatic birth play a vital role in the manifestation of this psychotic condition by creating a ‘perfect storm’ for mental deterioration. Recent studies have shown that mothers with bipolar disorder preceding birth have a 50% chance of developing the condition. It’s the speed the condition develops, together with the severity which makes it so dangerous as those amenable to their situation become fluidly unwell, delusional and paranoid in the space of a few days. 

Although it is a medical emergency, the victim herself is often unaware of her severity, therefore, responsibility for detection must fall onto relatives. During this phase she can find it difficult to have a bond with their child and can experience violent thoughts endangering both individuals. The most severe symptoms last between two and 12 weeks. This includes being uncharacteristically elated, depressed, anxious, strange beliefs or hallucinations.

Treatment for this unpredictable disorder can be divisive and the outcomes long term, therefore, the majority of the time she will need to be treated in specialist mother and baby units (MBUs) due to the danger both baby and mother may be in. Allowing both individuals to remain together during treatment is vital as separation would be detrimental. If not treated immediately, she can get rapidly worse and could neglect or harm her baby or herself.

There is no evidence that the baby’s long term development is affected by Postpartum Psychosis. However, if these specialist mother and baby units aren’t available, she will go to a general psychiatric unit while the family care for the baby. This is not ideal as this separation will adversely affect the her recovery and their relationship later on in life. The mother will stay in the general unit until a place in a specialist unit is available. Due to the increased awareness and medical knowledge of mental health nowadays, these units are often stretched as demand outweighs supply.

In terms of drugs, treatment included a prescription of antidepressants to help ease symptoms of depression, antipsychotics, to help with manic and psychotic symptoms and mood stabilisers such as lithium. At this time of medicinal consumption, women are advised not to breastfeed as the long term effect on babies is unknown. Electroconvulsive therapy, or ECT for short, is a controversial treatment where electric currents are passed through the brain to relieve psychotic symptoms. ECT is only used rarely for women who have severe symptoms or don’t respond to other treatment. More commonly, doctors may suggest  cognitive behaviour therapy when the patient is in recovery along with regular counselling and home visits as a period of anxiety, depression or a lack of self-confidence often follows.

Postpartum psychosis sufferers should make a full recovery within six to twelve months although misdiagnosis and lack of knowledge in this area can cause a delay in recovery.