No ‘latent period’ in the onset of bipolar affective puerperal psychosis

Department of Psychiatry, University of Birmingham, Birmingham, UK.
Archives of Women s Mental Health (Impact Factor: 2.16). 02/2007; 10(2):79-81. DOI: 10.1007/s00737-007-0174-z
Source: PubMed


The weeks following childbirth are a period of high risk in bipolar women with manic or mixed affective episodes following 20-30% of deliveries. Although the vast majority of episodes have their onset within 2 weeks of delivery it is commonly believed that there is a "latent" or symptom-free period in the first few days after delivery. We examine the day of onset of clinically significant symptoms in 101 bipolar women who have experienced an episode of puerperal (postpartum) psychosis. We find no evidence of a latent period. Over 50% of symptom onsets occur on days 1-3, with over 22% occurring on the first postpartum day.

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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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    ABSTRACT: The aim of the study was to describe Swedish psychiatrists’ experiences of involving the family in the treatment of women with postpartum psychosis. A qualitative design was used, and semistructured qualitative research interviews were conducted with nine psychiatrists from the south of Sweden. Data were analysed using qualitative content analysis. Four categories were found: the family as a resource , the family as coworkers , preparing the family for the future , and the family as a burden . The result showed that the psychiatrists considered the family to be a resource to which they devoted a great deal of care and effort. It was particularly important to involve the partner, informing about the course of the illness and the steps that need to be taken in the event of a relapse and reducing any guilt feelings. The psychiatrists instilled confidence and hope for a future of health and further child bearing. The family members’ limited understanding of the treatment may impede the involvement of the family. Conclusion of the study was that the goal for family involvement was to facilitate the women’s care and treatment. Further studies are needed to provide suggestions on how to develop family involvement in the care of women suffering from postpartum psychosis.
    Full-text · Article · Jan 2013
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    • "PPP occurs in 0.1– 0.2% of women who have just given birth (Brockington 2004; Spinelli 2009; Valdimarsdottir et al. 2009), with an incidence of 5% for suicide and 4% for infanticide (Knops 1993; Lindahl et al. 2005). The onset of PPP is usually rapid, as early as 1–3 days immediately after childbirth, with 22% occurring on the first post-partum day (Heron et al. 2007; Okano et al. 1998). The woman presents with paranoid, grandiose, or bizarre delusions that are usually associated with the baby, mood swings, confused thinking , anxiety and/or panic, and grossly disorganized behaviour that represents a dramatic change from her previous level of functioning. "
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    ABSTRACT: The concept of nursing presence has been widely used in nursing and is a significant component of nursing practice. In order to increase our understanding of nursing presence, it needs to be studied in different contexts. In this study, a secondary analysis of interviews with 10 registered psychiatric nurses (RPN) in Sweden was conducted to explore nurses' descriptions of presence when caring for women with post-partum psychosis (PPP). Based on the research question: 'How do RPN describe nursing presence in the context of caring for women with PPP?' content analysis was used to analyze the data. Three categories emerged: the use of presence to protect, the use of presence to facilitate recovery, and the use of presence for learning. The findings underscore the importance of recognizing nursing presence as a strategy to improve psychiatric nursing for the benefit of the woman and her child, and as an important part of psychiatric nursing when providing compassionate and effective nursing care to this population.
    Full-text · Article · Oct 2010 · International journal of mental health nursing
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    • "One to two women per 1000 births develop PPP. The majority of cases occur within the first weeks (APA 2000) after childbirth, with a rapid onset of delusions, hallucinations and impaired reality (Heron et al. 2007, 2008) that are most likely caused by radical hormonal changes combined with neurotransmitter overactivity (Brockington 2004, Sharma et al. 2004, Cantwell & Cox 2006). Given how acute and severe the illness is, the majority of patients need hospitalization (Murray et al. 2003, Lanczik et al. 2006, Noorlander et al. 2008). "
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    ABSTRACT: The focus was to describe Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. Data were analysed using manifest and latent content analysis. The results of these experiences were categorized in this study as: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards; and decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was exceedingly important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams, e.g. outpatient clinic, child health clinic and community services, was required. The conclusions were that psychiatrists collaborate with different professionals in the various phases of the caring process. They rely extensively on nurses' competence when caring for women with PPP, and consider nurses to be their most important collaborators.
    Full-text · Article · Aug 2010 · Journal of Psychiatric and Mental Health Nursing
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