August 2012, Volume 42 Number 8 , p 44 - 46
AFTER CHILDBIRTH, SOME WOMEN experience postpartum depression, and in most instances it subsides without treatment. In rare cases, however, women experience the sudden onset of psychotic symptoms following childbirth, a dangerous medical condition known as postpartum psychosis (PP). This article explores how to identify patients at risk for PP, what signs and symptoms to assess for, and how to support them and their families during treatment.Postpartum depression is estimated to occur in 15% of new mothers, but PP is rare, occurring in only 1 to 2 of 1,000 new mothers. Over 50% of women with PP have delusions that their baby is being harmed or killed, and approximately 4% commit infanticide.1A woman with postpartum depression may be listless and report feelings of worthlessness. In contrast, a woman with PP loses contact with reality and experiences psychotic symptoms, such as hallucinations and delusions (see Recognizing PP). For example, she may become convinced that something is terribly wrong with her baby, or that someone is trying to harm her baby. These delusions may cause her to harm herself or the baby, or to entertain thoughts of doing so.Women who experience PP may or may not have a history of mental disorders, but the risk is greater for those who have a personal or family history of mental illness. Women with a history of bipolar disorder, schizophrenia, schizoaffective disorder, and PP with previous pregnancies have a higher risk of developing PP.Signs and symptoms of PP typically appear soon after childbirth, usually within 2 weeks of delivery, but some women don't experience symptoms until several months later.2 Although the cause of PP is unknown, signs and symptoms appear to be triggered in high-risk women by the rapid hormonal changes that occur after childbirth.3During prenatal visits, ask questions to help determine if your patient may be at risk for PP, such as: * Have you or anyone in your family had a mental illness or psychiatric treatment?