For numerous women, giving birth is associated with a great physical effort and a mental experience. A completely new situation awaits the woman, as she is now a mother, with all the demands that the baby brings. Many women in childbed react to this with sad moods. Usually this subsides after a few days, but it can develop into postpartum psychosis in rare cases.
What is postpartum psychosis?
About three percent of women who have given birth are affected by postpartum psychosis. This is due, for example, to the hormonal changes that occur after childbirth. Traumatic birth experiences, the sudden motherhood role, and a large sleep deficit also promote the disorder. Postpartum psychosis is the most severe form of mental crises that occur after pregnancy. In this case, there can be a loss of reference to reality. The affected women need immediate help. Postpartum psychosis is divided into three forms, which occur individually, but equally as mixed forms:
- Mania
Mania is a form of postpartum psychosis. It is manifested by motor restlessness, sudden strong increase in drive, brief euphoria, delusions of grandeur, confusion, a decreased need for sleep, poor judgment. Disinhibition may also occur, which can be a danger to the child.
- Depression
Another form is depression, which is manifested by apathy, disinterest and anxiety. Feelings of guilt and hopelessness may also occur.
- Schizophrenia
Schizophrenia is also a form of postpartum psychosis. This is manifested by severe disturbances of moods, perception and thinking. The mothers suffer from hallucinations. They believe they hear strange voices and see things that do not exist.
Causes
Why postpartum psychosis occurs is still controversial. According to conjecture, hormonal changes in particular may be a trigger, such as the drop in concentration of estrogen and progesterone in the maternal bloodstream. Social and psychological factors probably also play a role, for example the attitude towards the child as well as towards the partner. If there is a history of mental illness, the risk of developing postpartum psychosis is greatly increased. A family history of stress is also a risk factor for the disorder. If relatives have already experienced psychotic or manic-depressive episodes, the mother is also at increased risk for postpartum psychosis. Furthermore, trauma resulting from childbirth in some women, a cesarean section, stress, and social distress may increase the risk for the disorder.
Symptoms, complaints, and signs
Postpartum psychosis is quite difficult to detect because hallucinations, delusions, or unreal fears are usually not seen by the affected person. In addition, sufferers often keep it quiet. This is done out of fear that they will be thought to be crazy. In addition, the symptoms often change very quickly, because the affected person can appear completely healthy in between and psychotically decompensate in the other moment. Above all, the psychotic symptoms are particularly difficult to recognize and classify as such. This is true for the affected person as well as for the family, especially when the psychosis occurs for the first time. In postpartum psychosis, concentration disorders, memory disorders, interruptions or racing of thoughts can be observed, as well as disjointed thinking, which is often noticeable when speaking. In addition, there may be a reduced or increased drive, and social withdrawal of the affected persons is not uncommon. In addition, they are plagued by restlessness or rigidity of movement as well as states of agitation. The mood can be euphoric, irritable to aggressive, depressive or strongly anxious, desperate and hopeless. The mood alternates greatly between the different extreme states. Compulsive thoughts, impulses or actions occur rather rarely within the psychosis, and difficulties in falling asleep or sleeping through the night occur very often. In addition, either a lack of energy or excessive energy is evident. Many affected persons suffer from pain without an organic cause or physical insensations.Usually, productive psychotic symptoms are present in postpartum psychosis, for example, delusions, hallucinations, and influencing experiences. In connection with the psychotic symptoms, suicidal ideation and, in the worst cases, even suicidal acts often occur.
Diagnosis and course of illness
The diagnostic measures for puerperal psychosis are similar to those for psychotic disorders. Since it must often first be ruled out that the psychosis does not result from drug use, a blood sample is usually taken to test for drug residues, but likewise inflammatory markers and elevated liver values. Otherwise, the doctor asks the affected mother about the complaints and the period since when they exist to make the diagnosis of postpartum psychosis based on the typical symptoms.
Complications
Women with postpartum psychosis can sometimes become suicidal. The onset of suicidality may be gradual or sudden. Psychologists distinguish between latent and acute suicidality. In latent suicidality, for example, the affected person thinks about death or feels a vague desire to die. Acute suicidality, on the other hand, is characterized by intentions, plans, and active actions, up to and including a suicide attempt. In some women with puerperal psychosis, there is not only such a danger to self, but also to others. Postpartum psychosis may lead to aggression. In addition, it is possible that the affected woman harms or even kills her child. Intentional killings are also possible, which occur in delusion. Four percent are affected by this. In case of severe complications, voluntary treatment or even placement in a psychiatric hospital is possible. During the inpatient stay, postpartum psychosis can be treated, on the one hand, and the safety of the affected person and her child can be ensured, on the other. Some hospitals have mother-child rooms so that the newborn does not have to be separated from the mother as long as there is no danger to the child. Other complications that can also occur with postpartum psychosis are less severe compared to suicidality and infanticide. For example, additional depressive symptoms, mood swings, or psychosomatic complaints may occur.
When should you see a doctor?
Many women go through numerous emotional states immediately after childbirth. In most cases, emotional states regulate themselves within the first few weeks or months after giving birth. Immediately after childbirth, there are strong hormonal changes in the organism of the woman who has given birth. This leads to mood swings, sadness or euphoric states. In many cases, the mother’s personality is temporarily greatly changed. Normally, within a few days, the health condition improves and a doctor is not needed. However, if the mental abnormalities persist or increase significantly in intensity, a doctor must be consulted. In case of delusions, sudden changes in behavior or hallucinations, the affected person needs medical help. If the expectant mother is unable to adequately care for the infant, consultation with a physician should be sought. A physician should be called immediately for complaints such as voice aspirations as well as states of confusion. Severe hopelessness, guilt, and sudden changes in drive should be investigated and treated. If the affected person experiences a state of apathy followed immediately by intense euphoria, these are worrying developments. A diagnosis is necessary so that a treatment plan can be established as soon as possible. Observations should be discussed with a physician so that help can be initiated.
Treatment and therapy
Depending on the condition and its severity, postpartum psychosis is usually treated with medications such as neuroleptics and antidepressants. Often this is done in combination with psychotherapy. If postpartum psychosis is present, inpatient treatment is recommended because the psychotic mother is usually no longer able to care for her child and herself alone. In addition, in many psychoses there is a risk of suicide. A mother-child ward in a psychiatric hospital is advantageous so that the mother and child are not separated.It also gives the mother a sense of security in dealing with the child, which is often lost due to the acute illness. If postpartum psychosis occurs for the first time and is recognized and treated early, the chances are good that it will subside completely. However, the risk for further episodes remains elevated throughout life.
Prevention
It is thought that stress during pregnancy may be partly responsible for postpartum psychosis. Therefore, it is important to pay attention to balance and mental equilibrium.
Postpartum care
Unlike the so-called “baby blues,” postpartum psychosis can have severe consequences, which is why it is essential to treat it. Usually, treatment is done as an inpatient, and in some cases, the mother is partially or completely separated from the newborn for this purpose. This can be useful so that the mother can first regain her strength and overcome the psychosis without distractions. However, the relationship between her and the child suffers significantly. During aftercare, it is therefore important to re-establish the relationship with the child. This must be done gently and very slowly so as not to overburden the mother. She often feels guilty because she thinks that she did not take sufficient care of the child at the beginning. She may feel that she has missed her chance. Acknowledging and expressing these feelings is important to overcome them. The mother should therefore have a trustworthy contact person who does not condemn her for her feelings. The relationship with the child can be established through the development of a breastfeeding relationship, but this can also be too stressful for the mother, especially if problems with breastfeeding occur. Then it is sufficient if the relationship building is done through other physical closeness, be it bathing together, baby massage or sharing with other parents in a toddler group.
Here’s what you can do yourself
In many cases, postpartum psychosis subsides on its own. In cases of severe psychosis with depressive moods and delusions, a doctor should be consulted. Not only the patients, but also the relatives often need support from professional therapists. The most important self-help measure is to remain active and to accept the medical advice. Contact with other sufferers can also be very important. Individual problems can be easily discussed in a self-help group, and patients often receive valuable tips on how to deal with postpartum psychosis themselves when talking to other sufferers. The causes of postpartum psychosis must also be investigated together with the doctor. Sometimes the symptoms are simply due to a hormonal imbalance, while in other cases serious health problems or deep emotional disturbances are responsible for the symptoms. In either case, the triggers must be identified before effective treatment of postpartum psychosis is possible. Sufferers should talk to their gynecologist and take advantage of psychotherapeutic support. In most cases, therapy is needed well beyond the acute phase of the illness. Because of the high risk of recurrence, the mother must be closely accompanied after a new birth.
