Makindo Medical Notes

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |Delusions |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression |Postpartum / Postnatal Psychosis

Treatment: Requires hospitalisation 🏥. Antipsychotics and/or antidepressants are often needed, sometimes alongside mood stabilisers or ECT. Postpartum psychosis is a psychiatric emergency.

📚 Background

• Incidence: ~1 in 500–800 deliveries (rare but serious).
• Onset: Typically begins 2–7 days postpartum, peaks by ~2 weeks.
• Distinct from postpartum depression/anxiety → psychotic features present.
• Rapid onset + high risk = medical emergency 🚨.

🧠 Diagnosis

• Based on presence of psychotic symptoms:
  • Delusions: Often about infant (health, identity, harm).
  • Hallucinations: Voices or visions (e.g. commands to harm baby or self).
  • Cognitive impairment: Disorganised thinking, poor concentration, confusion.
  • Mood instability: Mania, depression, or mixed features.
• Often preceded by severe insomnia + agitation ⚡ → early warning sign.

👩‍👦 Clinical Features

• Unawareness of illness (due to psychosis).
• Severe mood disturbance (manic and/or depressive).
• Disordered thought content (bizarre or paranoid).
• Profound insomnia 😵.
• Inappropriate responses to baby.
• Life-threatening risk for both mother and infant if untreated 🚨.

⚠️ Risk Factors

• History of psychosis or bipolar disorder (esp. untreated).
• Previous postpartum psychosis (high recurrence risk).
• Primiparity 👶 (first-time mother).
• Psychosocial stress: marital conflict, poor support.
• Stopping psychiatric meds during pregnancy (esp. mood stabilisers).

🛠️ Management

• Immediate hospitalisation: Ensure maternal + infant safety. 👉 Suicide risk ↑ 70-fold in first postpartum year.
• Pharmacological:
  • Antipsychotics for psychotic symptoms.
  • Mood stabilisers (e.g. lithium, valproate, carbamazepine) – esp. bipolar disorder.
  • Short-term sedatives (benzodiazepines) for insomnia/agitation.
• ECT: Considered if high risk of harm or resistant to meds.
• Close monitoring needed: early-onset psychosis (within 1 month) responds better to rapid treatment.
• In schizophrenia: recurrence risk postpartum = 30–50% 🔄.
• Long-term care: Psychiatric follow-up, relapse prevention, support for parenting.

📊 Teaching Table