Postnatal: Puerperal psychosis

Question 1

Define puerperal psychosis.

Answer 1

Psychotic disorder arising after birth, usually within 4w

Question 2

Give 3 risk factors for puerperal psychosis?

Answer 2

Hx postpartum psychosis.

PMH bipolar disorder.

FH postpartum psychosis or bipolar disorder.

Question 3

What 5 depressive symptoms may present due to puerperal psychosis?

Answer 3

Withdrawal
Confusion
Loss of competence
Distraction
Catatonia

Question 4

What 4 manic symptoms may present due to puerperal psychosis?

Answer 4

Elation
Lability
Agitation
Rambling

Question 5

What psychotic symptoms may arise due to puerperal psychosis?

Answer 5

Delusions: paranoia, jealousy, persecution, grandiosity
Hallucinations: auditory, visual, olfactory or tactile.
Odd beliefs about the baby.

Question 6

Summarise the epidemiology of puerperal psychosis.

Answer 6

1/500 births

Question 7

What investigations should be performed for puerperal psychosis?

Answer 7

Rule out delirium due to infection.

Question 8

What is the management for puerperal psychosis?

Answer 8

Assess risk for mother + child.

Admit (+/- MHA) mother + baby unit.

Medicate as appropriate (AP + mood stabilisers).

ECT if medication has failed.

Supportive psychotherapy during/ after recovery

Question 9

What is the prognosis of puerperal psychosis?

Answer 9

Most recover in 6-12w

Risk of recurrence rate is 1/2 for subsequent pregnancies