Puperal Psychosis

INSTITUTIONS :JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND
TECHNOLOGY.
COLLEGE:COLLEGE OF HEALTH SCIENCES.
SCHOOL: SCHOOL OF NURSING.
UNIT CODE:INS2303.
UNIT :MIDWIFERY III.
LECTURER:MRS. ROSEMARY MUGAMBI.
GROUP MEMBERS:
FEDINAND NYABUTO > HSN 211-0077/2017
JOAN CHEROP. > HSN 211-0043/2017
DIANA KEMUNTO. > HSN 211-0038/2017
SAMUEL BOGONKO. > HSN 211-0004/2017
ESTHER WANJIKU. > HSN 211-0051/2017
MONICA WANJIKU. > HSN 211-0050/2017
NANCY OBONYO. > HSN 211-0033/2017
ASSIGNMENT :POSTPARTUM COMPLICATIONS – PUERPERAL PSYCHOSIS.

PUERPERAL [POSTPARTUM] PSYCHOSIS
Severe mental illness which develops acutely in the early postnatal period.
Globally, puerperal psychosis, the most severe form of postpartum affective

(mood) disorder has been recognized and described since antiquity. It leads to 2 in
1000 women being admitted to a psychiatric hospital following childbirth, mostly
in the first few weeks postpartum. Although a relatively rare condition, there is a
marked increase in the risk of suffering from a psychotic illness following
childbirth (Kendell et al 1987; Munk-Olsen et al 2012). It is also remarkably
constant across nations and cultures.
Risk factors
Most women who suffer from this condition will have been previously well,
without obvious risk factors, and the illness comes as a shock to them and their
families. However, some women will have suffered from a similar illness following
the birth of a previous child, some may have suffered from a non-postpartum
bipolar affective disorder from which they have long recovered or they may have
a family history of bipolar illness. For others there may be marked psychosocial
adversity. It is generally accepted that biological factors (neuroendocrine and
genetic) are the most important aetiological factors for this condition. This implies
that puerperal psychosis can and does strike without warning, women from all
social and occupational backgrounds – those in stable marriages with much-
wanted babies as well as those living in less fortunate circumstances.
Other organic causes include: ischaemic or haemorrhagic stroke, electrolyte

imbalance such as hyper/hyponatremia, hyper/hypoglycaemia, thyroid or
parathyroid abnormalities ,vitamin B12,folate and thiamine deficiencies and
sepsis
Clinical features
Puerperal psychosis is an acute, early onset condition. The overwhelming majority

of cases present in the first 14 days postpartum. They most commonly develop
suddenly between day 3 and day 7, at a time when most women will be
experiencing the ‘blues’. Differential diagnosis between the earliest phase of a
developing psychosis and the ‘blues’ can be difficult. However, puerperal
psychosis steadily deteriorates over the following 48 hours while the ‘blues’ tends
to resolve spontaneously.
During the first 2–3 days of a developing puerperal psychosis there is a fluctuating
rapidly changing, undifferentiated psychotic state. The earliest signs are
commonly of perplexity, fear – even terror – and restless agitation associated with
insomnia. Other signs include: purposeless activity, uncharacteristic behaviour,
disinhibition, irritation and fleeting anger, and resistive behaviour and sometimes
incontinence.
A woman may have fears for her own and her baby’s health and safety, or even
about its identity. Even at this early stage, there may be, variably throughout the
day, elation and grandiosity, suspiciousness, depression or unspeakable ideas of
horror.
Women suffering from puerperal psychosis are among the most profoundly
disturbed and distressed found in psychiatric practice (Dean and Kendell 1981). In
addition to the familiar symptoms and signs of a manic or depressive psychosis,
symptoms of schizophrenia (delusions and hallucinations) may occur. Depressive
delusions about maternal and infant health are common. The behaviour and
motives of others are frequently misinterpreted in a delusional fashion. A mood of
perplexity and terror is often found, as are delusions about the passage of time
and other bizarre delusions. Women can believe that they are still pregnant or
that more than one child has been born or that the baby is older than it is.
Women often seem confused and disorientated. In the very common mixed
affective psychosis, along with the familiar pressure of speech and flight of ideas,
there is often a mixture of grandiosity, elation and certain conviction alternating
with states of fearful tearfulness, guilt and a sense of foreboding. The sufferers
are usually restless and agitated, resistive, seeking senselessly to escape and
difficult to reassure. However, they are usually calmer in the presence of familiar
relatives.
The woman may be unable to attend to her own personal hygiene and nutrition
and unable to care for her baby. Her concentration is usually grossly impaired and
she is distractible and unable to initiate and complete tasks. Over the next few
days her condition deteriorates and the symptoms usually become more clearly
those of an acute affective psychosis. Most women will have symptoms and signs
suggestive of a depressive psychosis, a significant minority a manic psychosis and
very commonly a mixture of both – a mixed affective psychosis.
Relationship with the baby
Some women are so disturbed, distractible and their concentration so impaired

that they do not seem to be aware of their recently born baby. Others are
preoccupied with the baby, reluctant to let it out of their sight and forever
checking on its presence and condition. Although delusional ideas frequently
involve the baby and there may be delusional ideas of infant ill health or changed
identity, it is rare for women with puerperal psychosis to be overtly hostile to
their baby and for their behaviour to be aggressive or punitive. The risk to their
baby lies more from an inability to organize and complete tasks, and to
inappropriate handling and tasks being impaired by their mental state. These
problems, directly attributable to the maternal psychosis, tend to resolve as the
mother recovers.
Management
Most women with psychotic illness following childbirth will require admission to
hospital, which should be to a specialist mother and baby unit, the only setting in
which the physical needs of the mother who has recently given birth can be met
and where specialist psychiatric nursing is available. This ensures that the physical
and emotional needs of both mother and baby are met and the developing
relationship with the baby promoted.
Prognosis
In spite of the severity of puerperal psychoses, they frequently resolve relatively

quickly over 2–4 weeks. However, initial recovery is often fragile and relapses are
common in the first few weeks. As the psychosis resolves, it is common for
women to pass through a phase of depression and anxiety and preoccupation
with their past experiences and the implications of these memories for their
future mental health and their role as a mother. Sensitive and expert help is
required to assist women through this phase, to help them understand what has
happened and to acquire a ‘working model’ of their illness. The overwhelming
majority of women will have completely recovered by 3–6 months postpartum.
However, they face at least a 50% risk of a recurrence should they have another
child and some may go on to have bipolar illness at other times in their live.
Reference:
1.Myles Textbook for Midwives, African 3rd Edition. Edited by J. Marshall et al.
2.Oxford handbook of midwifery 2nd Edition. Edited by J. Medforth et al.

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INSTITUTIONS :JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND

COLLEGE:COLLEGE OF HEALTH SCIENCES.

SCHOOL: SCHOOL OF NURSING.

UNIT :MIDWIFERY III.

LECTURER:MRS. ROSEMARY MUGAMBI.

FEDINAND NYABUTO > HSN 211-0077/2017

JOAN CHEROP. > HSN 211-0043/2017

DIANA KEMUNTO. > HSN 211-0038/2017

SAMUEL BOGONKO. > HSN 211-0004/2017

ESTHER WANJIKU. > HSN 211-0051/2017

MONICA WANJIKU. > HSN 211-0050/2017

NANCY OBONYO. > HSN 211-0033/2017

ASSIGNMENT :POSTPARTUM COMPLICATIONS – PUERPERAL PSYCHOSIS.

Globally, puerperal psychosis, the most severe form of postpartum affective

Other organic causes include: ischaemic or haemorrhagic stroke, electrolyte

Puerperal psychosis is an acute, early onset condition. The overwhelming majority

Some women are so disturbed, distractible and their concentration so impaired

In spite of the severity of puerperal psychoses, they frequently resolve relatively

2.Oxford handbook of midwifery 2nd Edition. Edited by J. Medforth et al.

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