What is a puerperal psychosis?
About three percent of those who have recently given birth are affected by a puerperal psychosis. The reason for this is, for example, the hormonal changes that occur after birth. Traumatic birth experiences, the sudden mother role and a large sleep deficit also favor the disease.
Puerperal psychosis is the most severe form of emotional crisis that occurs after pregnancy. This can lead to the loss of reality. The affected women need immediate help. The postpartum psychosis is divided into three forms, which occur individually but also as mixed forms:
Mania is a form of puerperal psychosis. It is characterized by motor restlessness, sudden strong drive increase, short euphoria, megalomania, confusion, a reduced need for sleep, lack of judgment. Also, a disinhibition may occur, which can be a danger to the child.
Another form is depression, characterized by apathy, disinterest and anxiety. Guilt and hopelessness can also occur.
Schizophrenia is also a form of puerperal psychosis. This is shown by strong disturbances of the emotions, perception and thinking. The mothers suffer from hallucinations. They believe that they hear strange voices and see things that do not exist.
Why the puerperal psychosis occurs, is still controversial. According to guesses, especially hormonal changes as triggers in question, for example, the concentration decrease of estrogen and progesterone in the maternal bloodstream. Social and psychological factors are also likely to play a role, such as attitudes toward the child and the partner.
If mental illness has already occurred in prehistory, the risk of developing puerperal psychosis is greatly increased. A family burden is also a risk factor for the disease. If relatives have already undergone psychotic or manic-depressive episodes, there is also an increased risk to the mother that postpartum childbirth psychosis occurs.
In addition, trauma to some women at birth, caesarean section, stress and social distress can increase the risk of the disease.
Symptoms, complaints & signs
A puerperal psychosis is quite difficult to recognize because hallucinations, delusions or unreal fears are usually not considered. In addition, it is often concealed from those affected. This happens out of fear that they are thought to be crazy.
In addition, the symptoms often change very quickly, because the affected person can appear completely healthy in between and in the other moment psycho-decompensate. Above all, the psychotic symptoms are particularly difficult to recognize and classify as such. This applies to those affected as well as to the family, especially if the psychosis occurs for the first time.
Concerning puerperal psychosis, concentration disorders, memory disorders, interruptions of thoughts or tears can be observed, as well as distracted thinking, which is often noticeable when speaking. In addition, there may be a reduced or increased drive, even social withdrawal of those affected is not rare. They plague motor unrest or rigidity as well as states of excitement.
The mood can be euphoric, irritable, aggressive, depressed or very anxious, desperate and hopeless. The mood changes very much between the different extreme states. Forced thoughts, impulses or actions tend to occur rarely within psychosis, and one or more drowsiness often occurs.
In addition, either show a lack of energy or an oversized energy. Many sufferers suffer from pain without any organic cause or physical discomfort. In most of the puerperal psychosis productive-psychotic symptoms are present, for example, delusions, hallucinations and influencing experiences. Suicidal thoughts and, in the worst case, suicidal behavior are often associated with the psychotic symptoms.
Diagnosis & disease course
The diagnostic measures are similar to those of psychotic disorders in a puerperal psychosis. Since it must be first and foremost ruled out that the psychosis does not result from a drug use, blood is usually taken to examine for drug residues, but also inflammation markers and elevated liver values.
Otherwise, the doctor will ask the affected mother about the symptoms and the length of time they have passed to diagnose postpartum psychosis based on the typical symptoms.
Women with postpartum psychosis can sometimes become suicidal. Suicide may be creeping or sudden. Psychologists distinguish between latent and acute suicidality. In latent suicidality, for example, the person in question thinks of death or has a vague desire to die.
Acute suicidality, on the other hand, is characterized by intentions, plans, active actions, and suicide attempts. In some women with a puerperal psychosis is not only such a risk to themselves, but also an external hazard. The puerperal psychosis can lead to aggression. In addition, it is possible that the affected woman harms or even kills her child.
It also intentional killings are possible that happen in delusion. Four percent are affected by it. In case of severe complications, voluntary treatment or even placement in a psychiatric clinic is possible. During in-patient treatment, on the one hand, the post-partum psychosis can be treated and on the other hand, the safety of those affected and their child can be ensured.
Some clinics have mother-and-child rooms so the baby does not have to be separated from the mother unless the child is at risk. Other complications that may also occur in puerperal psychosis are less severe compared to suicidality and child killing. For example, depressive symptoms, mood swings or psychosomatic complaints may also occur.
When should you go to the doctor?
Many women go through numerous emotional states immediately after giving birth. In most cases, the emotional state is regulated within the first few weeks or months after birth. Immediately after birth, there are strong hormonal changes in the organism of the unbound wife. This leads to mood swings, sadness or euphoric states. In many cases, the personality of the mother has temporarily changed significantly.
Normally, the condition improves within a few days and a doctor is not needed. However, if psychic abnormalities persist or increase significantly in intensity, a doctor must be consulted. In case of delusions, sudden changes in behavior or hallucinations, the person concerned needs medical help. If the expectant mother can not care enough for the care of the baby, the consultation with a doctor should be sought.
In the case of complaints such as voice feedback and confusion, a doctor should be called immediately. A strong hopelessness, feelings of guilt and sudden changes in the drive should be examined and treated. If the sufferer experiences a state of apathy and immediately afterwards an intense euphoria, these are alarming developments. For a treatment plan to be created as soon as possible, a diagnosis is necessary. The observations should be discussed with a doctor for assistance.
Treatment & Therapy
Depending on the disease and severity, puerperal psychosis is usually treated with drugs such as neuroleptics and antidepressants. Often this is done in combination with a psychotherapy. With a puerperal psychosis present, inpatient treatment is recommended because the psychotic mother is usually no longer able to care for her child and herself.
In addition, many psychoses are at risk of suicide. An advantage is a mother and child ward in a psychiatric hospital, so that the mother and the child are not separated. The mother is also taught the safety in dealing with the child, which is often lost due to the acute illness.
If a puerperal psychosis occurs for the first time and is detected and treated early, the chances are good that it completely dies away. The risk of further episodes, however, remains lifelong.
It is believed that stress during pregnancy could be partly responsible for a puerperal psychosis. Therefore, it is important to pay attention to balance and mental balance.
In contrast to the so-called "baby blues" a puerperal psychosis can have serious consequences, which is why it must be treated. Most of the treatment is inpatient, in some cases, the mother is partially or completely separated from the newborn. This can be useful, so that the mother can regain her strength and overcome the psychosis without distraction. However, the relationship between her and the child suffers significantly.
In aftercare, it is therefore important to restore the relationship with the child. This must be gentle and very slow so as not to overwhelm the mother. She often feels guilty because she thinks she did not care enough for the child at the beginning. She might get the feeling that she missed her chance. The perception and expression of these feelings is important in overcoming them.
Therefore, the mother should be supported by a trustworthy contact person who does not condemn her for her feelings. The relationship with the child may be through the establishment of a breastfeeding relationship, but this may also be too stressful for the mother, especially if problems with breastfeeding occur. Then it is sufficient if the relationship is established through other physical closeness, whether by bathing together, baby massage or sharing with other parents in a toddler group.
You can do that yourself
A puerperal psychosis sounds in many cases by itself again. In severe psychoses with depressive moods and delusions a doctor should be consulted. Not only the patients, but also the relatives often need the support of professional therapists.
The most important self-help measure is to stay active and take the medical advice. Very important can be the contact with other victims. As part of a self-help group, the individual problems can be discussed well and often the patients in conversation with other patients valuable tips for their own handling of the puerperal psychosis. Together with the doctor, the causes of the puerperal psychosis must also be investigated. Sometimes the symptoms are only due to a hormonal imbalance, in other cases, serious health problems or deep mental disorders are responsible for the complaints.
In any case, the triggers must be determined before effective treatment of puerperal psychosis is possible. Diseased persons should talk to the gynecologist and use psychotherapeutic support. Mostly the therapy is needed far beyond the acute phase of the disease. Due to the high risk of recurrence, the mother must be closely followed after a new birth.