[55] Post-Partum Psychosis

Question 1

What is post-partum psychosis?

Answer 1

A severe mental illness which develops acutely in the early post-natal period

Question 2

When does post-partum psychosis develop?

Answer 2

Usually within first month following delivery

Question 3

What is the importance of postpartum psychosis?

Answer 3

It is a psychiatric emergency

Question 4

What is the epidemiology of post-partum psychosis?

Answer 4

Occurs in 1-2/1000 deliveries

Question 5

What are the leading causes of late maternal death in the UK?

Answer 5

Suicide and psychiatric disorders

Question 6

What are the risk factors for post-partum psychosis?

Answer 6

• Past history of post-partum psychosis
• Past history of bipolar disorder
• Family history of post-partum psychosis or bipolar disorder

Question 7

What is post-partum psychosis thought to be?

Answer 7

May be a manifestation of underlying bipolar disorder

Question 8

What are the possible contributing factors to the develoment of post-partum psychosis?

Answer 8

• Sleep deprivation
• Hormonal changes
• Stress
• Genetic influences

Question 9

How can the symptoms of post-partum psychosis progress?

Answer 9

Can rapidly progress from mild anxiety to severe psychosis

Question 10

What is the result of the rapid progression of symptoms in post-partum psychosis?

Answer 10

The diagnosis can easily be missed

Question 11

How can you avoid missing the diagnosis of post-partum psychosis?

Answer 11

All significant changes to mental state in the postnatal period should be closely monitored, and should trigger referral to specialist services

Question 12

What are the categories of symptoms of post-partum psychosis?

Answer 12

• Depressive symptoms
• Manic symptoms
• Delusions
• Hallucinations
• Odd beliefs about the baby

Question 13

What are the depressive symptoms of post-partum psychosis?

Answer 13

• Withdrawal
• Confusion
• Loss of competence
• Distraction
• Catatonia

Question 14

What are the manic symptoms of post-natal psychosis?

Answer 14

• Elation
• Lability
• Agitation
• Rambling

Question 15

What delusions may be present in post-partum psychosis?

Answer 15

• Paranoia
• Jealousy
• Persecution
• Grandiosity

Question 16

What hallucinations may be present in post-partum pscyhosis?

Answer 16

• Auditory
• Visual
• Olfactory
• Tactile

Question 17

What are the differential diagnoses of post-partum psychosis?

Answer 17

• Major depression with psychotic features
• Schizophrenia
• Bipolar disorder with post-partum onset
• Organic causes

Question 18

What are the organic differentials for post-partum psychosis?

Answer 18

• Ischaemic or haemorrhagic stroke
• Hypoglycaemia or hyperglycaemia
• Side effects of medication
• Thyroid or parathyroid abnormalities

Question 19

Where will investigation to confirm the diagnosis of post-natal psychosis take place?

Answer 19

Secondary care

Question 20

What will investigations to confirm the diagnosis of post-natal psychosis be guided by?

Answer 20

Presentation

Question 21

What might the investigations to confirm the diagnosis of post-partum schizophrenia involve?

Answer 21

Blood tests and possibly CT/MRI scanning

Question 22

What is meant by post-partum psychosis being a medical emergency?

Answer 22

It requires urgent assessment, referral, and usually admission

Question 23

Where should a mother with post-partum psychosis be admitted?

Answer 23

Preferably to a specialist mother and baby unit

Question 24

What is the primary management of post-partum psychosis?

Answer 24

Pharmacological

Question 25

How is the drug used in post-partum psychosis decided?

Answer 25

The guidance is the same as for other causes of psychosis, however the choice of medication must take breast-feeding into account

Question 26

What does the medication for post-partum psychosis usually involve?

Answer 26

An anti-psychotic and/or mood stabilising drug

Question 27

When should mothers on treatment for post-partum psychosis be advised not to breastfeed?

Answer 27

If they are on lithium treatment

Question 28

Why should mothers taking lithium be encouraged not to breastfeed?

Answer 28

Due to toxicity to the infant

Question 29

What anti-psychotic medication should not be used in breastfeeding women?

Answer 29

Clozapine

Question 30

Are anti-psychotics excreted in breast milk?

Answer 30

Most are

Question 31

Does excretion of anti-psychotics into the breast milk cause harm to the baby?

Answer 31

Little evidence that it causes harm

Question 32

What should be done when anti-psychotics are prescribed to a breast-feeding woman?

Answer 32

The baby should be monitored for side effects

Question 33

What management for post-partum psychosis can be considered in some cases?

Answer 33

ECT

Question 34

What non-medical management is important in post-partum psychosis?

Answer 34

• 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

Question 35

What is the prognosis of post-partum psychosis?

Answer 35

Prognosis for complete recovery is good, but there is a significant risk of recurrence

Question 36

What is the risk of recurrence of post-partum psychosis in subsequent pregnancies?

Answer 36

1 in 2

Question 37

What should happen to women who have been diagnosed with post-partum psychosis if they become pregnant again?

Answer 37

They should be monitored very closely, and referred early