Symptoms of postpartum psychosis
Symptoms range from depression with apathy and guilt to gross disturbances of perception in the form of illusions and hallucinations, thinking disorders in the form of obsessive, overvalued and delusional thoughts. Postpartum psychosis is usually preceded by a period of disturbed sleep and anxiety.
Fear may seem justified at the beginning (concern for the child’s health, doubts about proper nutrition), but as the painful condition develops, it becomes absurd and completely covers the sick person.
In a state of psychosis, dangerous aggressive behavior may occur. Therefore, it is very important to consult a psychiatrist at the first signs of postpartum psychosis, or even if you suspect its development.
In the vast majority of cases, postpartum psychoses are completely reversed.
Causes of postpartum depression
There is an opinion that the cause of postpartum depression is a sharp hormonal imbalance in a woman’s body, which manifests itself immediately after the birth of the baby. During the development of pregnancy, significant changes of a psychological , somatic and endocrine nature occur in a woman’s body. Mental dysfunction in the period after childbirth, according to doctors, is associated with a sharp decrease in the amount of gonadotropic hormones .
However, there are some factors that increase the risk of postpartum depression. First of all, it is important to consider that postpartum depression most often manifests itself in those women who previously suffered from such a disease when giving birth to children. Postpartum depression occurs especially often in this category of women when a child is born after 35 years of age. However, there is evidence that postpartum depression occurs much more often in women at the birth of their first child.
In addition, the risk of manifestation of this condition significantly increases the lack of adequate support for the young mother, which should be provided by relatives and friends. Postpartum depression occurs more often in women who have experienced severe stress . It can be triggered by health problems in the newborn, regular colic in the child, or the presence of other family or psychological problems.
If a woman was susceptible to depression during the period of bearing a child, then in 75% of cases a depressive state will manifest itself in her after childbirth. The young mother's hereditary predisposition to depression or bipolar disorder .
Where and how is postpartum psychosis treated?
Treatment of postpartum psychosis includes drug therapy, psychotherapy, physical therapy and restorative procedures.
An important role in the treatment of postpartum psychosis is played by isolation from external stimuli, normalization of hormonal levels, restoration of nutrition and sleep patterns.
Newly occurring and not severe postpartum psychoses can be treated at home (outpatient). If symptoms are severe, hospitalization in a hospital will be required for a period of several days to a month.
If psychosis occurs with aggressive behavior, loss of a critical attitude towards one’s condition, then one has to resort to involuntary hospitalization (in accordance with the law of the Russian Federation). The sick person can be hospitalized in a state psychiatric hospital or in a private psychiatric clinic.
Treatment of postpartum psychosis in a private clinic is more comfortable and often takes place in a shorter time.
Types of postpartum depression
In medical practice, a certain classification of postpartum depression has been adopted. With neurotic depression in a woman, those disorders that occurred during pregnancy become aggravated. She is depressed, often cries, and gradually reaches an extreme degree of nervous exhaustion .
Traumatic neurosis , as a rule, appears after a very difficult birth process. In women who have experienced a difficult birth, before the next birth of a child, a state of anxiety and obsessive fears gradually increases.
With melancholy, which is accompanied by delusional inclusions , the woman’s condition is characterized by severe lethargy, a feeling of guilt, as well as thoughts of her own failure. A woman may not recognize people close to her and suffer from the constant manifestation of unpleasant hallucinations. Very often, this condition precedes the manifestation of manic-depressive psychosis .
With postpartum depression with a neurotic component, a woman may experience symptoms of a hypochondriacal nature, as well as insomnia and a feeling of powerlessness. The mother is constantly afraid of harming her child in some way.
Most often, young mothers experience a prolonged course of postpartum depression. Moreover, this condition very often goes undiagnosed in women, although approximately 20% of young mothers suffer from it. Symptoms of this condition include a constant feeling of fatigue, despondency, and exhaustion. It is very difficult for a mother to tolerate the baby's crying; she becomes irritable, and at the same time constantly feels guilty for such behavior.
Main etiological factors
The economic situation remains in first place in terms of importance of the reasons provoking such violations. Financial problems associated with both pregnancy (expensive examinations, medications) and the upcoming birth seriously affect the mental state. Living conditions are also of great importance (lack of own housing, the need to live with relatives with whom the relationship is not very good).
Also the cause of mental disorder can be:
- sudden changes in hormonal levels (estrogen, cortisol, thyroid hormone) and other biologically active substances
(serotonin, endorphins); - family history of mental illness;
- the presence of depression, psychosis, neurasthenia or diagnosed mental disorders in a woman already at the time of pregnancy;
- unsuccessful pregnancy, in which not only already diagnosed developmental pathologies in the fetus are important, but also doctors’ forecasts regarding congenital disorders (especially if the doctor is not particularly tactful when delivering bad news);
- unwanted child;
- psychotrauma during pregnancy (divorce from husband, death of loved ones, etc.);
- complications during childbirth;
- lack of psychological support;
- miscarriage or intrauterine fetal death during a previous pregnancy;
- neuroinfections, organic brain lesions.
The psychotype of the woman herself also plays an important role. Suspicious, emotional individuals who usually exaggerate existing problems are prone to the development of postpartum psychosis. Risk factors also include depressive episodes, hysterical psychoses, panic attacks, a history of suicide attempts, alcoholism, and drug addiction.
More about symptoms
The disease begins in the first two weeks after birth, less often in the first days, and most rarely after a few weeks. The first manifestations of the disorder are insomnia, irritability and anxiety.
Other symptoms of postpartum psychosis:
- an unreasonable and inadequate feeling of euphoria, “high,” a feeling that the patient is “on top of the world” or “at the center of the universe”;
- bad mood and tearfulness;
- restlessness, excitement, irritability over trifles;
- rapid mood changes, sometimes several times a day;
- detachment from the outside world;
- constant rapid flow of thoughts;
- changes in behavior and character;
- excessive sociability and talkativeness;
- isolation and refusal to communicate with loved ones;
- difficulty falling asleep, lack of desire to sleep;
- removal of prohibitions, including moral ones, the patient performs actions that were previously unusual for her;
- suspicion, fear, feeling of persecution;
- feeling of being in a fantasy world, daydreams, illusions;
- misconceptions, thoughts that cannot be true (for example, that a woman won the lottery or that her relatives want to take the child, etc.);
- hallucinations: the patient sees, hears, feels or smells something that is not really there;
- inner voices that can order harm to the child.
All these symptoms make it difficult to care for yourself and your newborn. The mother becomes suspicious, does not trust others, may secretly perform dangerous procedures on the newborn (for example, pouring cold water on her), and does not trust doctors. Such a patient constantly monitors the newborn’s breathing, behavior, and nutrition, often believing that the child is terminally ill, but no one sees this. She cannot logically explain her suspicions, and gradually becomes more and more mentally exhausted.
At this stage, excessive care for the baby can develop into hatred towards him. A young mother can be sure that an evil spirit has taken possession of the newborn, and he will inevitably die soon. At this time, she experiences vocal hallucinations, and the voices she hears may command her to harm the baby.
Usually the patient does not understand that she is sick. However, her loved ones clearly see that she needs specialist help. It is vital to receive the correct treatment during this time.
Causes and trigger factors
Postpartum psychosis is not the woman's fault. It is not related to her or her loved ones' behavior, nor is it caused by relationship problems, stress, or pregnancy problems.
The exact causes of the development of mental disorders have not been established. It is believed that family history and genetic predisposition, as well as fluctuations in the levels of estrogen, progesterone and thyroid hormones, are important; changes in sleep and wakefulness after the birth of a child.
The risk of developing the disease increases if you have:
- bipolar disorder;
- schizoaffective disorder;
- stopping taking medications prescribed by a psychiatrist during pregnancy;
- previous postpartum psychosis;
- mother or sister has the same disease.
The last two factors increase the likelihood of developing the disease to 50%. However, not only patients with mental disorders, but also completely healthy women are at risk of the disease.
There are other objective signs that increase the risk of developing the disease:
- complicated pregnancy and childbirth, excessive blood loss, premature birth, death of the fetus or newborn, endometritis and blood poisoning - sepsis;
- concomitant diseases of the brain - previous traumatic brain injury, chronic intoxication (alcoholism, drug addiction, substance abuse), infections with damage to the brain and its membranes (encephalitis and meningitis);
- characteristics of a woman’s character, increased anxiety, fear, excitability (stress during childbirth becomes a trigger for a complete imbalance in the processes of inhibition and activation in the brain);
- poor socio-economic conditions, difficult family conditions, unwanted child, divorce, unsettled life, prostitution.
Prevention of postpartum mental disorders
It should be understood that the prevention of postpartum depression and postpartum psychosis must be taken care of long before the birth of the child. The expectant mother should always be in a comfortable environment to feel cared for and supported. It is especially important to provide such conditions for women who have an increased risk of developing mental disorders. In this case, the attitude of her partner towards the woman is extremely important.
Both husband and wife must understand before giving birth that every woman has a risk of developing postpartum depression, so it is important to recognize this condition in time and provide adequate treatment.
Diagnosis of postpartum depression
Diagnosis of postpartum mental disorders is carried out through a medical examination, as well as a detailed interview with the patient. It is extremely important that the woman tells the doctor in as much detail as possible about her own feelings, thoughts and emotions that prevail in her after the birth of the child. During the treatment process, the doctor must monitor the patient and monitor her psychological state. It is important that the doctor pays close attention to the woman’s complaints, since mental disorders sometimes go unnoticed.
Diagnostics
Often the problem is that family members pay little attention to the psychological state of the woman in labor. The symptoms of the disorder are “attributed” to fatigue, lack of sleep, general weakness after childbirth, and anxiety that is quite natural for the mother.
In addition, in our country, the diagnosis of postpartum psychosis is made when there are obvious signs of agitation, delirium, and hallucinatory disorders. This is due to the late start of treatment, and as a result, the insufficient effect of therapy. In addition, while a woman is in such a state, there is a real threat to the health of the baby.
That is why, when the first suspicion arises that something is “wrong,” it is better not to postpone a visit to the Leto clinic or, which is clearly more convenient in such a situation, to call a specialized specialist at home. First of all, an infectious cause of the disorder should be excluded. In addition to standard tests (blood, urine, etc.), this is also indicated by the woman’s condition (increased temperature up to 38°, pain, signs of systemic intoxication). It is also necessary to evaluate the secretory activity of the thyroid gland and the level of other hormones.
In the absence of organic pathology, algorithms for questioning the patient are used to diagnose postpartum psychosis, and the answers are assessed in accordance with a special scale. The resulting sum of points allows one to objectively determine mental status and prescribe appropriate treatment.
