Article

Early postpartum symptoms in puerperal psychosis

Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 03/2008; 115(3):348-53. DOI: 10.1111/j.1471-0528.2007.01563.x
Source: PubMed

ABSTRACT To examine the nature of the earliest reported symptoms in women who develop a bipolar affective puerperal psychosis (PP).
A retrospective interview study.
Women were recruited for clinical and molecular genetic studies of PP from a national PP network, articles in the national press and referrals from UK specialist perinatal psychiatry services.
One hundred and twenty-seven women met the criteria for an episode of strictly defined bipolar affective PP developing within 4 weeks of childbirth.
Participants were interviewed using the Schedule for clinical assessment in neuropsychiatry and hospital records were reviewed. Lifetime and puerperal episode diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) based on all the available information. During interview, participants were asked to describe the earliest symptoms they believed to be related to their illness onset. The day of onset for each symptom was recorded.
We present subjectively experienced emotional and behavioural changes occurring within 3 days of childbirth, reported by four or more women.
Seventy-three percent of women recalled experiencing an onset of symptoms by day 3. The most commonly recalled symptoms were feeling excited, elated or high (52%), not needing to sleep or not able to sleep (48%), feeling active or energetic (37%) and talking more or feeling very chatty (31%).
Hypomanic symptoms are particularly characteristic of the early postpartum in women who develop PP. These types of symptoms should be carefully monitored in individuals at high risk of PP episodes.

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    • "The consequences could be traumatic and sometimes result in suicide and infanticide [14]. The majority of cases occur within the first few weeks [15] after childbirth, with a rapid onset of delusions, hallucinations, and impaired reality [16] [17]. The prognosis for PPP is favourable. "
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    • "Postpartum depression refers to a non-psychotic depressive episode that often requires treatment and affects approximately 13% of mothers within 12 weeks of giving birth (O'Hara and Swain 1996). PP is more severe than postpartum depression, often requiring hospitalization, and is characterized by delusions, hallucinations, bizarre behavior, depression, mania, and mood lability that usually presents within the first 2 weeks postpartum (Heron et al. 2008; Sit et al. 2006). "
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    • "Lack of concentration was a prominent symptom in this study, where nine of the women stated that they were incapable of watching television, reading a paper, or concentrating in a talk or discussion. Lack of concentration was found in approximately 29% of women with PPP, where 127 women were interviewed (Heron et al., 2008). It is interesting to note that so many of the women reported a lack of satisfaction with the staff that cared for them. "
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    ABSTRACT: The aim of this study was to gain an insight into women's experiences of postpartum psychosis (PPP). Ten narratives taken from the Internet, which met the definition of PPP, were analyzed using cross-case and content analyses. The results revealed women's experience of having unfulfilled dreams, being enveloped by darkness, having disabling symptoms, and being abandoned. The women's experiences point to the importance of further education of nurses and doctors concerning PPP. It is vital not only for those working in psychiatric health care but also midwives and nurses who are working in maternity wards and child welfare centers. This would facilitate early recognition of signs and symptoms of the disorder, which, in turn, would make early treatment possible, thus supporting recovery. Furthermore, greater knowledge could contribute to providing more effective and compassionate care for these women.
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