Puerperal Psychosis

Puerperal Psychosis

This is a severe mental illness in puerperium, which affects the personality of the woman. She loses contact with reality. The incidence is 1:1000 of birth. It is more common in primigravida. The incidence of psychotic disorders may begin in pregnancy, labour or puerperium.

Many women experience a phase of depression known as “maternity blue”

Predisposing Factors

1.           Normal pregnancy and labor may impose a degree of emotional strain on a woman of nervous temperament

2.           Severe stress in labor may precipitate psychiatric disorders- if there is history of mental instability in the family.

3.           Mal-adjusted personality when subjected to gross disharmony is liable to break down- predisposition to mental illness

4.           Heredity

5.           Infection may lead to confusion

Signs and Symptoms

1.           Persistent insomnia – early sign

2.           May refuse meal

3.           May be depressed and weepy

4.           Unusual sadness, anxiety or irritability may be elated and talkative, there maybe confusion or delusion

5.           Excessive self doubt – may hate husband, baby or th e nurse

6.           Idea of guilt or self blame

7.           Hallucination – visual and auditory

8.           Suicidal tendencies – self and baby

9.           Disorientation and liability of mood – sudden laugh ter or depression

10.      Unwarranted suspicion and persecutory ideas

11.      Odd way of handling baby

Management

Prevention:

1.           Help your patient to overcome fear by dispelling false information.

2.           Create confidence in your patient

3.           Recognize early signs and give appropriate care in mild cases and refer to Dr.

4.           Proper screening and selection of predisposed cases for Dr’s management

o     History of  mental illness in family

o     Previous history of depression in Puerperium

o     Undue anxiety in 1st trimester

5.           Give good care and love to women in Puerperium

Active Treatment:

o     Sedation – Chlopromazine (Largactil) 50mg

Librium 10-20mg

Barbiturate-phenobarb 30-60mg

o     Take baby away

o     Isolate in a single room

o     Remove harmful objects from surrounding

o     Encourage to eat – Nourishing diet

o     General Nursing care

o     Suppress lactation if necessary

o     Electrol convulsive therapy

o     Induction of hypoglycaemia – insulin

o     Antibiotic in case of infection

o     Transfer to psychiatric hospital if necessary

Prognosis is good if well managed