How Is Postpartum Psychosis Treated

What is postpartum psychosis?

How Is Postpartum Psychosis Treated (PPP) is a major issue in the post-pregnancy period. It is a reversible psychological problem, but it is much more severe. Also, it rarely happens with women, but it is dangerous for their mental health.

In this severe stage, women have higher chances of hurting themselves, attempting suicide, and harming their children. So, this state of PPP is called a medical emergency. If anyone is fighting this symptom, you should discuss it with someone to get immediate medical attention. You must dial the local emergency number even if you see someone in this condition. 

Who gets affected? How Is Postpartum Psychosis Treated

Postpartum psychosis can harm especially those ladies who have given birth recently. Also, it can take a couple of days to affect the person, sometimes six weeks. 

PPP can be diagnosed in anyone, but the odds may have happened with some women who already have certain and severe mental illnesses. So, for them, the chances of PPP are high. Experts are not sure whether this mental state would cause PPP, but they predict there can be a link.

Statistical Report on postpartum psychosis 

With the elevated graph of catalogued global manifestation of postpartum psychosis, experts reveal the present state, i.e., 0.089 to 2.6 per 1000 deliveries. Though this emergency mental illness classifies the current scenario with a low incident rate, it still needs proper medical attention, social awareness, and medication. Also, there are high chances of suicide if it is not detected and medicated as soon as possible.

Case study

Sarah was a charming lady who had gone through forceps delivery after 41 weeks, which was a journey from failure to success because her body was full of liquor blended with sleazy meconium. So, this damages blood up to 500ml. But her newborn baby was healthy, fit, and fine without complications.

The medical team recorded her health condition as low-risk when she was admitted. Also, doctors learned that she was taking ferrous fumarate to prevent pre-determined anaemia. She had no previous family history of such serious mental instability. After much research and surveys, the mental health team discovered that the girl had a brother with a severe hearing disability. Also, at that time, the situation at her home was extremely complicated.

Though having a serious mental problem, she joined a health professional team as she was good at English. That time, she had an interpreter in the booking. She kept interacting with her family often, and those remained forever in her hometown after she migrated to another country. On the other hand, her husband needed to be more conversant in English and needed an assistant. 

After a few days, a tiny symphysial-fundal height assessment and a long span of fetal distress made her panic. After one day of the operation, healthcare personnels took her to a midwife care. But, from the 11th day, the midwife started noticing strange behavioural patterns in her. After noticing such weird changes, they decided to admit her to the hospital. At that time, she too declined and agreed to get the hospitalization. One day later, her husband came to see her and took her to the A&E due to her dire condition wherein she presented confusion, fever, and disorientation.

In the A&E, one of the perinatal mental health team members suspected that Sarah had an issue with a psychotic episode. Then they collaborated with the best doctor’s group including obstetricians from the perinatal mental health facility to identify the best possible way for her treatment. Eventually, Sarah was admitted to the postnatal department and medicated with antibiotics and paroxetine. On day 24, they transferred her to the mother and baby unit

How does postpartum psychosis happen?

Medical experts don’t have a clear conception of postpartum psychosis. Also, after much research, experts still suspect there are some reasons behind this mental illness. They noted some factors that might be responsible for this disease, including family mental health history, bipolar disorder, and others. Most patients with this symptom were diagnosed with a sign of previous mental sickness. 

1. When does postpartum depression start?

Many wonders when they hear PPP can be seen in the fourth, sixth, or eighth month of giving birth. According to the American College of Obstetricians and Gynecologists (ACOG) Report, PPD can happen anytime within one year of baby birth. But, if you can identify the symptoms at 1-3 weeks, it will be easier for medical persons to start treatment.    

2. Postpartum psychosis pathophysiology

Postpartum depression is not the mother’s doing, but her body’s. For a woman, a whole world comes to a close when the doors open to a new child. It is often tough to handle it, but what make it worse are the additional factors contributing to the depression. If the body’s hormones change, or if you are genetically predisposed to it, and even immune disorders cause havoc, you cannot blame a mother, but her entire body, the flesh that makes it.

1. Hormonal factors tend to play a crucial role{ is postpartum psychosis curable}

Estrogen and progesterone are the factors that come together when we talk of hormonal changes in a woman’s body.

• Not only do they regulate your uterus and ovaries, but also your thyroid, lactogenic hormones, and even the hypothalamic–pituitary–adrenal axis, including your immune and genetic systems.
• Changes in reproductive hormones will cause a variety of changes in our bodies and mind. The way we think, perceive and observe the world undergoes rapid change.

The reality around us changes and this causes us to become increasingly distinct, to the point where we are unable to relate to others. Depression is an obvious outcome of it and once it sets in postpartum life, it becomes difficult to manage. You will need to undergo appropriate rehabilitation to get back to life without depression once again.

2. Genetic changes How Is Postpartum Psychosis Treated

Genetic studies have shown interesting observations.

• One such observation is found in the Val66Met polymorphism of brain-derived neurotrophic factor.
• The genetic variation of the chromosomes observed in 1200 women revealed chromosomes 1q21.3-q32.1 and 9p24.3-p22.3, as well as Hemicentin-1 (HMCN1). Several oestrogen binding sites can be found here.
• Estrogen can also induce DNA methylation changes.

3. Immunity changes

The immune axis present in our body is regulated by estradiol. During the perinatal period, anti-inflammatory cytokines are raised. After birth, it remains pro-inflammatory for a long time and is frequently elevated for several weeks or months. Gene expressions in relation to postpartum depression can be a causative factor in making things worse for PPD patients.

How to treat postpartum psychosis?

Postpartum psychosis medication

Postpartum psychosis is an emergency state of mental illness. Often a carrier of this disease will receive medical attention at a healthcare centre for the first few days. After that, when her mental state becomes stable, assuring that she will not harm herself anymore, she will get discharged. Someone needs to help her out and take her to an immediate crisis centre or emergency care unit.

During the PPP period, experts provide medication to lessen depression and anxiety, ballast the mind state, and reduce psychosis. Examples include:

Antipsychotics: This medication treatment reduces the phase of hallucination. It includes;

• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify).

Mood stabilizers: This treatment includes a different medication that treats manic symptoms. It includes;

• Lithium (Lithobid)
• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal)
• Divalproex sodium (Depakote).

There is no particular treatment or medication for postpartum psychosis because every woman has symptoms and mental instabilities. So, they respond differently to antidepressants instead of other drugs or combined medicines.

If any woman does not respond to the above-stated medical treatment, she needs more advanced medication, like; ECT (electroconvulsive shock therapy). This treatment is more effective than the previous one. In this technique, medical experts involve electrotherapy by stimulating the brain with electromagnetic induction.

The effect of this electric therapy is that the brain starts working again properly by resetting the created imbalance, which causes Postpartum psychosis episodes. It also cures the problem generated by bipolar disorder.

Postpartum psychosis prevention. How Is Postpartum Psychosis Treated

Postpartum psychosis prevention for postnatal psychosis is to determine whether the person has a higher risk of psychological exhaustion. It also recognizes the forthcoming postnatal psychosis through medical screening and medication.

Some useful preventives are antipsychotic drugs, ECT and hormonal therapy, and mood stabilizers. These emergency medical services can reduce the risks of psychosis. 

Postpartum psychosis nursing care plan

Nursing Management

Nursing management says that nurses should be alert in identifying a patient’s mental unhealthiness and psychological state. They provide needed nursing care plan to reduce the risk of having postpartum depression.

Nursing Assessment

• Nurses assess a woman’s mental health before the delivery.
• They study the patient’s family psychological history and cases.
• Also, they go through the history of patients’ diseases to provide prior counselling before the delivery.

Nursing Diagnosis

• They diagnose impaired patients with an inability to perform daily tasks and secondary living harmed by postpartum depression.
• Nursing Interventions
• They assist women in doing their daily activities like other normal people. 
• They recommend a good association where she can open up her mind and share her words.
• They advise the woman to spend some time with herself to get an interval from the daily baby care plan. 

Conclusion How Is Postpartum Psychosis Treated

A mother’s psychological state massively affects her physical condition, especially during delivery. So, a healthy lifestyle and fitness should ensure that she can care for her infant properly and safely. Also, bonding between a mother and her toddler should be holistically good.

Case Study Link: