Postnatal: Puerperal psychosis

Question 1

Define puerperal psychosis.

Answer 1

Psychotic disorder arising after childbirth.

Question 2

What is the aetiology of puerperal psychosis?

Answer 2

Strong asociation with bipolar affective disorder (>genetic predisposition)

Question 3

What are the risk factors for puerperal psychosis?

Answer 3

Associated with past Hx

Bipolar

FHx

Primigravida

Question 4

Summarise the epidemiology of puerperal psychosis.

Answer 4

1/500 births

Question 5

What are the signs and symptoms of puerperal psychosis?

Answer 5

Usually within 1 month of delivery but may be in first few days. Rapid fluctuations of mood and abrupt onset of disturbed behavior.

Marked restlessness and fear. Mixture of manic and depressive features. Delusions and hallucinaitons may be based around baby or auditory hallucinatory commands. Perplexed but not cognitively impaired.

Question 6

What investigations should be performed for puerperal psychosis?

Answer 6

Rule out delirium due to infection.

Question 7

What is the management for puerperal psychosis?

Answer 7

Assess risk for mother and child.

Admit (with or without MHA) mother and baby unit.

Medicate as appropriate (AD, sedatives, AP).

ECT if medication has failed. Supportive psychotherapy.

Question 8

What are the complications associated with puerperal psychosis?

Answer 8

Harm or neglect of child

Infanticide

Suicide

Lack of bonding and attachment disorders.

Question 9

What is the prognosis of puerperal psychosis?

Answer 9

Most settle in 6wk and fully recover by 6m

Recurrence rate is 50% for subsequent normal psychosis, 25% for subsequent puerperal psychosis.