Understanding Postpartum Psychosis

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Psychosis is a mental health condition characterized by a disconnection from reality.[1] Unfortunately, the stigma surrounding the term can perpetuate many misconceptions, and for new mothers, the experience of postpartum psychosis (PPP) can be particularly isolating.

The societal pressure to embody the image of a blissful, fulfilled new mother can overshadow the reality that mental health challenges are not uncommon in the postpartum period. Women grappling with postpartum psychosis may find themselves facing both the inherent internal challenges the condition brings and the external judgments and misunderstandings that so often accompany it.

Today’s blog acknowledges the unique struggles faced by new mothers contending with postpartum psychosis. The journey to mental well-being is multifaceted, and Clear aims to break down stigmas and provide support through informative resources, compassionate care, and community understanding for a brighter, healthier future.

What is Postpartum Psychosis?

Postpartum psychosis, also called puerperal psychosis and postnatal psychosis is a very serious mental illness that can occur in the days, weeks, or months following childbirth. It is a relatively rare but serious psychiatric illness that involves a break from reality and can lead to significant impairment in overall functioning.[2]

It’s important to note that postpartum psychosis is different from postpartum depression, which is more common and less severe.[3] Postpartum depression is characterized by persistent feelings of sadness, anxiety, and fatigue, but it does not typically involve a break from reality.

What Are the Primary Symptoms of Postpartum Psychosis?

Postpartum psychosis is characterized by a range of psychotic symptoms that typically emerge within the first few weeks after childbirth.[4] The severity and specific symptoms can vary from person to person.

Some of the primary symptoms of postpartum psychosis include:

  • Delusions: These are strong, irrational beliefs that are not based in reality. Women experiencing postpartum psychosis may have delusions that may involve themes related to the baby, themselves, or others. For example, they may believe the baby has special powers or that they are in grave danger.
  • Hallucinations: Women may experience sensory perceptions that are not real, such as hearing voices, seeing things, or feeling sensations that others do not. Hallucinations can be distressing and contribute to the overall disorientation.
  • Extreme mood swings: Rapid and intense mood fluctuations are common in postpartum psychosis. This can involve periods of intense elation, followed by severe depression or agitation. The mood swings may be more extreme than typical mood changes experienced after childbirth.
  • Disorganized thinking: Individuals may have difficulty organizing their thoughts, and their speech may become incoherent or illogical. Disorganized thinking can contribute to confusion and make communication challenging.
  • Agitation or restlessness: Increased levels of restlessness, pacing, or heightened activity can be observed in individuals with postpartum psychosis. This may be accompanied by a sense of urgency or anxiety.
  • Insomnia or altered sleep patterns: Disturbances in sleep, such as insomnia or a decreased need for sleep, may be present. Sleep disturbances can exacerbate other symptoms and contribute to the overall impairment in functioning.
  • Impaired judgment: Women with postpartum psychosis may engage in risky or impulsive behaviors due to impaired judgment. This could include neglecting personal hygiene, making poor financial decisions, or engaging in activities that could be harmful to themselves or others.

What Causes Postpartum Psychosis?

The exact cause of postpartum psychosis is not fully understood, but it is likely to result from a combination of biological, hormonal, psychological, and environmental factors:[5]

  • Hormonal fluctuations: Hormonal changes that occur during and after childbirth are believed to play a role in the development of postpartum psychosis. The sudden drop in estrogen and progesterone levels after delivery may contribute to the onset of symptoms. However, the precise relationship between hormones and postpartum psychosis is complex and not completely understood.
  • Genetic predisposition: There may be a genetic or familial component to postpartum psychosis. Women with a family history of bipolar disorder or psychotic disorders may be at a higher risk. Genetic factors likely interact with other influences to increase susceptibility.
  • Biological factors: Neurobiological factors, such as alterations in brain structure and function, may contribute to the development of postpartum psychosis. The brain undergoes significant changes during pregnancy and childbirth, and disruptions in these processes could potentially contribute to psychiatric symptoms.
  • Psychological factors: Individuals with a history of psychiatric disorders, particularly bipolar disorder or schizoaffective disorder, may be at a higher risk for postpartum psychosis. Stressful life events, lack of social support, and difficult childbirth experiences can also be contributing psychological factors.
  • Sleep deprivation: The demands of caring for a newborn often result in disrupted sleep patterns for new mothers. Sleep deprivation has been linked to an increased vulnerability to mood and psychotic disorders, and it may exacerbate the symptoms of postpartum psychosis.
  • Personal history of mental health issues: A history of mental health issues, especially mood disorders or psychosis, can increase the risk of PPP. Women who have previously experienced postpartum psychosis are also at a higher risk in subsequent pregnancies.

It’s important to recognize that postpartum psychosis is a rare condition, and not all women with the identified risk factors will develop this condition.[6] The interplay of various factors and individual differences makes it challenging to predict who will be affected.

When Does Postpartum Psychosis Typically Occur?

Postpartum psychosis typically occurs in the first few weeks after childbirth, with onset often happening within the first two weeks postpartum.[7] However, it can manifest anytime during the first few months following delivery. The majority of cases emerge within the first month, making early detection and intervention crucial.

The exact timing can vary among individuals, and it’s important to note that postpartum psychosis is considered a psychiatric emergency. The rapid onset and severity of symptoms necessitate immediate medical attention. Women experiencing PPP may display symptoms that are markedly different from their usual behavior, and the condition can progress rapidly without intervention.

If there are concerns about mental health after childbirth, seeking prompt and appropriate care is crucial. Mental health professionals, obstetricians, and primary care providers can play a key role in evaluating symptoms, providing support, and coordinating appropriate treatment. In severe cases, hospitalization may be necessary to ensure the safety of the mother and baby unit.

Who is At Risk?

Postpartum psychosis is a severe mental illness that can emerge in the weeks following childbirth, typically within the first two weeks postpartum. While it is relatively rare, its severity nevertheless demands attention and immediate intervention. Certain factors can increase the likelihood of developing PPP, shedding light on who may be at a heightened risk.[8]

History of Psychotic Disorders

One significant risk factor is a personal or family history of bipolar disorder or other psychotic disorders. Women with a history of these conditions face an increased vulnerability, as do those who have experienced postpartum psychosis in a previous pregnancy. First-time mothers may also be at a slightly higher risk, emphasizing the importance of awareness and support for individuals navigating the postpartum period for the first time.

Psychosocial Factors

Psychosocial factors, such as high levels of stress or exposure to significant life events, can contribute to the risk of postpartum psychosis. Disrupted sleep patterns, common after childbirth, are another factor that may elevate susceptibility. The importance of a robust support system cannot be overstated, as the lack of social support is associated with an increased risk of postpartum mental health issues.

While these factors can heighten the risk, it’s crucial to recognize that the majority of women with these risk factors do not develop PPP. However, understanding these risk factors can help healthcare providers, families, and individuals themselves remain vigilant and proactive in monitoring mental health during the postpartum period. Early intervention, support, and appropriate treatment significantly contribute to positive outcomes for both the affected individual and the newborn. If there are concerns about mental health, seeking guidance from healthcare professionals and support networks is essential for timely evaluation and intervention.

Is Postpartum Psychosis Related to Postpartum Depression or Other Perinatal Mood and Anxiety Disorders (PMADs)?

While postpartum psychosis, postpartum depression, and other perinatal mood and anxiety disorders (PMADs) all fall under the umbrella of mental health conditions that can affect women during the perinatal period, they are each referring to distinct disorders with different characteristics.

Postpartum Psychosis

  • Severity: PPP is the most severe among these conditions and is considered a psychiatric emergency. It involves a break from reality, with symptoms such as hallucinations, delusions, extreme mood swings, and impaired judgment.
  • Onset: PPP typically occurs in the first few weeks after childbirth, and it requires immediate medical attention.

Postpartum Depression

  • Severity: While serious, postpartum depression is generally less severe than postpartum psychosis. It involves persistent feelings of sadness, hopelessness, and fatigue.
  • Onset: Postpartum depression can emerge within the first few weeks after childbirth and may last for several months or longer if left untreated.

Perinatal Mood and Anxiety Disorders (PMADs)

  • Scope: PMADs encompass a broader range of mood and anxiety disorders that can occur during pregnancy and up to one year postpartum. This includes conditions such as generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder, in addition to postpartum depression and postpartum psychosis.
  • Onset: Symptoms of PMADs can emerge either during pregnancy or after childbirth.

While these conditions are distinct, there is some overlap in risk factors. For example, a history of major depression or other mood disorders may increase the risk of both postpartum depression and postpartum psychosis. It’s important for healthcare providers to be vigilant in assessing and addressing the mental health needs of pregnant and postpartum individuals and to tailor interventions based on the specific condition and its severity. Early detection and appropriate treatment are critical for the well-being of both the mother and the baby.

How is Postpartum Psychosis Treated?

If you or someone you know is exhibiting symptoms of postpartum psychosis, seeking immediate help is critical. This condition is deemed a psychiatric emergency, demanding swift intervention for the well-being and safety of both the affected individual and the baby.

Treatment Options

Urgent assistance can be obtained by dialing 911, visiting the nearest emergency room, or reaching out to an inpatient mental health treatment center. The severity of this psychotic illness usually requires an inpatient level of care where individuals are constantly supervised by a trained mental health team.

Common treatments for PPP include:

  • Psychiatric Hospitals: Due to the intense disconnection from reality that new mothers experience throughout PPP, inpatient mental health treatment is often in the form of involuntary hospitalization. Some people suffering from PPP are unaware of their current condition and must be placed under a psychiatric hold.
  • Inpatient Mental Health Treatment Centers: Clear Behavioral Health’s residential mental health treatment center provides a unique opportunity for mothers to receive treatment in a home-like setting. Our facility provides multimodal therapy, individualized treatment plans, expert psychiatric care, 24-hour supervision, and everything else required to treat postpartum psychosis.
  • Electroconvulsive therapy (ECT): This method utilizes a mild electrical current that passes through the brain to trigger a mild seizure. The induced seizure causes changes in the brain which function to correct the effects of PPP. ECT requires anesthesia, must be performed in a hospital, and can have various side effects including nausea, headaches, fatigue, confusion, and slight memory loss. That being said, it is a safe and effective treatment for PPP.
  • Medications: Psychiatric medications are a very common treatment for PPP as they work to quickly stabilize psychotic symptoms. Patients may be treated by a mental health provider with a regimen of antipsychotics, mood stabilizers, anti-seizure medications, and lithium.
  • Outpatient Mental Health Treatment: Once individuals are stable, following up inpatient treatment with an outpatient program is recommended for continued support. PHP and IOP provide ongoing therapy as well as case management and psychiatric care. Participating in group therapy and frequent sessions with a therapist can lead to lasting change.

Seek Additional Support

In conjunction with these immediate measures, consider reaching out to helplines or crisis services specializing in mental health. Organizations like Postpartum Support International (PSI) can offer support and valuable information on local resources, fostering a more comprehensive approach to addressing PPP. You can also contact 988 to speak with someone immediately throughout the US.

Furthermore, involving loved ones in the situation can help to both ease the isolation and garner the additional support you need to recover. Family and friends can play a pivotal role in ensuring the safety, well-being, and emotional support you need in a time of crisis, creating a vital network that contributes to a stronger foundation for recovery.

How Can I Get Help For Postpartum Psychosis?

Remember: you never have to struggle alone. With a commitment to breaking down stigmas and providing compassionate care, Clear Behavioral Health offers resources and guidance for individuals facing mental health challenges. With the right support, there is a path towards healing and well-being. If you or a loved one is struggling with a mental health condition, contact Clear Behavioral Health to learn more about our inpatient mental health treatment for severe conditions, mental health outpatient for ongoing support, and virtual IOP that allows you to access treatment from the comfort of your own home.

 References:

  1. National Institute of Mental Health. (2020). Understanding psychosis. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis
  2. Raza, S. K., & Raza, S. (2019, November 18). Postpartum Psychosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544304/
  3. Postpartum depression vs. psychosis. (2023, May 26). Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/postpartum-depression-vs-psychosis
  4. Postpartum Support International. (2014). Postpartum Psychosis | Postpartum Support – PSI. Postpartum Support – PSI; Postpartum Support – PSI. https://www.postpartum.net/learn-more/postpartum-psychosis/
  5. Cleveland Clinic. (2022, September 13). Postpartum psychosis: What it is, symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24152-postpartum-psychosis
  6. NHS. (2020, September 29). Postpartum psychosis. Nhs.uk. https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/
  7. VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L., & Cohen, L. S. (2017). The global prevalence of postpartum psychosis: a systematic review. BMC Psychiatry, 17(1). https://doi.org/10.1186/s12888-017-1427-7
  8. Upadhyaya, S., Sharma, A., & Raval, C. (2014). Postpartum psychosis: Risk factors identification. North American Journal of Medical Sciences, 6(6), 35. https://doi.org/10.4103/1947-2714.134373

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