[55] Post-Partum Psychosis Flashcards
What is post-partum psychosis?
A severe mental illness which develops acutely in the early post-natal period
When does post-partum psychosis develop?
Usually within first month following delivery
What is the importance of postpartum psychosis?
It is a psychiatric emergency
What is the epidemiology of post-partum psychosis?
Occurs in 1-2/1000 deliveries
What are the leading causes of late maternal death in the UK?
Suicide and psychiatric disorders
What are the risk factors for post-partum psychosis?
- Past history of post-partum psychosis
- Past history of bipolar disorder
- Family history of post-partum psychosis or bipolar disorder
What is post-partum psychosis thought to be?
May be a manifestation of underlying bipolar disorder
What are the possible contributing factors to the develoment of post-partum psychosis?
- Sleep deprivation
- Hormonal changes
- Stress
- Genetic influences
How can the symptoms of post-partum psychosis progress?
Can rapidly progress from mild anxiety to severe psychosis
What is the result of the rapid progression of symptoms in post-partum psychosis?
The diagnosis can easily be missed
How can you avoid missing the diagnosis of post-partum psychosis?
All significant changes to mental state in the postnatal period should be closely monitored, and should trigger referral to specialist services
What are the categories of symptoms of post-partum psychosis?
- Depressive symptoms
- Manic symptoms
- Delusions
- Hallucinations
- Odd beliefs about the baby
What are the depressive symptoms of post-partum psychosis?
- Withdrawal
- Confusion
- Loss of competence
- Distraction
- Catatonia
What are the manic symptoms of post-natal psychosis?
- Elation
- Lability
- Agitation
- Rambling
What delusions may be present in post-partum psychosis?
- Paranoia
- Jealousy
- Persecution
- Grandiosity
What hallucinations may be present in post-partum pscyhosis?
- Auditory
- Visual
- Olfactory
- Tactile
What are the differential diagnoses of post-partum psychosis?
- Major depression with psychotic features
- Schizophrenia
- Bipolar disorder with post-partum onset
- Organic causes
What are the organic differentials for post-partum psychosis?
- Ischaemic or haemorrhagic stroke
- Hypoglycaemia or hyperglycaemia
- Side effects of medication
- Thyroid or parathyroid abnormalities
Where will investigation to confirm the diagnosis of post-natal psychosis take place?
Secondary care
What will investigations to confirm the diagnosis of post-natal psychosis be guided by?
Presentation
What might the investigations to confirm the diagnosis of post-partum schizophrenia involve?
Blood tests and possibly CT/MRI scanning
What is meant by post-partum psychosis being a medical emergency?
It requires urgent assessment, referral, and usually admission
Where should a mother with post-partum psychosis be admitted?
Preferably to a specialist mother and baby unit
What is the primary management of post-partum psychosis?
Pharmacological
How is the drug used in post-partum psychosis decided?
The guidance is the same as for other causes of psychosis, however the choice of medication must take breast-feeding into account
What does the medication for post-partum psychosis usually involve?
An anti-psychotic and/or mood stabilising drug
When should mothers on treatment for post-partum psychosis be advised not to breastfeed?
If they are on lithium treatment
Why should mothers taking lithium be encouraged not to breastfeed?
Due to toxicity to the infant
What anti-psychotic medication should not be used in breastfeeding women?
Clozapine
Are anti-psychotics excreted in breast milk?
Most are
Does excretion of anti-psychotics into the breast milk cause harm to the baby?
Little evidence that it causes harm
What should be done when anti-psychotics are prescribed to a breast-feeding woman?
The baby should be monitored for side effects
What management for post-partum psychosis can be considered in some cases?
ECT
What non-medical management is important in post-partum psychosis?
- Education and supportive therapy for woman and her family
- Child protection services may need to be alerted
- Discharge should only occur with close follow up in place
What is the prognosis of post-partum psychosis?
Prognosis for complete recovery is good, but there is a significant risk of recurrence
What is the risk of recurrence of post-partum psychosis in subsequent pregnancies?
1 in 2
What should happen to women who have been diagnosed with post-partum psychosis if they become pregnant again?
They should be monitored very closely, and referred early
