What is Postpartum Psychosis?

Postpartum psychosis (PPD), also known as puerperal psychosis, refers to a mental disorder that occurs within 6 weeks after delivery. At present, most people think that this disease is not an independent disease unit, but that various mental illnesses occur during the puerperium. The imbalance of secretion during the puerperium and psychological factors may be the triggering factors. Generally, the onset is relatively rapid, and it is mainly divided into three categories: schizophrenia, manic depression and symptomatic psychosis. Postpartum schizophrenia symptoms fluctuate and affective disorders are prominent.

Basic Information

nickname: Puerperal psychosis
English name: postpartum psychosis
Visiting department: Psychiatry, Obstetrics and Gynecology
Multiple groups: Maternal

Common causes: The etiology is still unknown, and may be related to the combined effect of physiological-psychological-social factors
Common symptoms: Sadness, depression, crying, loneliness, anxiety, fear, irritability, etc., mental disorders, acute hallucinations and delusions, severe depression, etc.

Causes of postpartum psychosis

The exact etiology of postpartum psychosis is currently unclear, and many studies have suggested that its related factors are related to the combined effects of physio-psycho-social factors.

Biological factor

(1) The change of hormone levels in the postpartum is the biological basis of its occurrence.

(2) Studies have shown that postpartum HCG levels have decreased significantly, prolactin levels have risen rapidly, changes in hypothalamus-pituitary-adrenal axis function, and hypothyroidism have been linked to postpartum PPD

(3) Another study found that the reduction of serotonin and norepinephrine dopamine levels is related to postpartum depression, and this increase in neurological constitution is related to postpartum mania, and it is believed that postpartum -endorphin decreases rapidly. Increased ₂ -adrenal receptors are also associated with postpartum depression.

(4) Factors in this delivery: longer labor, cesarean delivery assisted by forceps, postpartum hemorrhagic infection, insufficient lactation, or neonatal factors, such as low birth weight neonatal asphyxia, complications during pregnancy and comorbidities, and postpartum Incidence of depression is also increasing

2. Psychological factors

Studies have found that women have psychological changes during pregnancy and pregnancy, such as fragile feelings and strong dependence. Therefore, various stimuli during pregnancy and pregnancy may cause psychological abnormalities. In addition to the above factors, unplanned pregnancy, anxiety and fear of childbirth, the health of the fetus, and the undesired anxiety of the baby to become a mother to take care of the child can cause psychological stress.

3. Social factors

Studies at home and abroad have shown that broken marriages or strained relationships, disunity between families, difficulties in life, lack of care and help from husbands and family members, and low levels of education and perinatal health services may be the causes of PPD.

Clinical manifestations of postpartum psychosis

The classification of postpartum depression has not been unified internationally. At present, most scholars divide PPD into two categories: postpartum depression (also known as postpartum depression) and postpartum psychosis:

Postpartum depression

Refers to transient crying or depression within 7 days after delivery. The main clinical manifestations of postpartum depression include sadness, depression, crying, loneliness, anxiety, fear, irritability, blame and guilt, inability to work, failure to perform mother's duties, lack of confidence in life, etc., accompanied by dizziness and weakness. , Insomnia, loss of appetite, decreased sexual desire and other physical symptoms.

Postpartum psychosis

It is a severe mental disorder and behavioral disorder related to the puerperium, and most of the patients are affected within 7 days after delivery. Postpartum psychosis is clinically characterized by complex and variable polymorphic courses and symptoms such as mental disorders, acute hallucinations and delusions, severe depression and manic crosses, and its biological characteristics are sleep disorders and dietary changes.

Postpartum psychiatric examination

1. Includes general examination, obstetric examination and laboratory examination to rule out mental disorders related to severe physical and brain diseases.

2. Psychological test

At present, there are no special psychological scales to assist in the diagnosis of postpartum psychosis at home and abroad, but you can refer to the following psychological scales:

(1) Minnesota Personality Questionnaire (MMPI) This form has been revised in China and has been widely used.

(2) Symptom Assessment Scale Currently, there are 90 Symptom Symptom Scales (SCL-90), Self-Depression Scale (SDS), and Anxiety Scale (SAS), etc. to understand the patient's emotional state.

(3) Event rating scale The life event scale (LES) is a widely used scale. The perinatal stress rating scale (PSS) is a scale that is being actively explored at home and abroad. Not only the risk factors, medical history and clinical characteristics related to the time of onset, but also comprehensive analysis such as systemic and obstetric laboratory tests and assisted psychological tests can make a correct diagnosis.

Postpartum psychiatric diagnosis

The biggest feature of postpartum psychosis is the appearance of pathological thinking. According to the time of onset and thinking characteristics, combined with a psychiatric scale, a diagnosis can be made and it can be distinguished from other puerperal mental disorders. Once a diagnosis of postpartum mental illness is made, it will have a great impact on patients and their families. Therefore, the diagnosis should be extremely cautious. If necessary, please consult a psychiatrist to confirm it. Postpartum depression usually occurs within 2 weeks after delivery, and the delivery process is 4-6 weeks. The symptoms are obvious. The clinical manifestations are the same as the symptoms of postpartum depression syndrome, but the severity is more serious, and even suicidal or infantile tendencies appear.

Postpartum psychiatric treatment

Experts believe that mild to moderate postpartum psychosis generally does not require treatment. The best treatment for postpartum psychosis is the same as that for non-puerperal psychosis. Most of these treatments include medications for mental illness to treat psychological problems and / or antidepressants as well as psychotherapy (usually focusing on psychoanalysis or giving treatment from a family perspective). Electric spasm is rarely used in general. Some postpartum psychosis can be treated with hormones. The use of thyroxine, pituitary hormones, sex hormones, and steroids is very effective in treating patients with postpartum psychosis who have ineffective thyroid or adrenal function and are ineffective in general methods.

Psychotherapy

Psychotherapy for emotional and behavioral problems of postpartum mental patients is necessary. Provide sympathy, patience, and philosophical explanations for patients 'psychological problems, encourage meticulous care, and provide guidance or counseling to release and release patients' emotions, properly evaluate the psychosocial stressors, eliminate adverse stimuli, relieve their pain, and enhance self-confidence , Do a good job of self-adjustment and adaptation, attach importance to the development of interpersonal psychotherapy, especially the psychological treatment of conflicts between husband and wife or family. But it requires the enthusiastic support and assistance of family members and all aspects of society.

2. Drug treatment

Tricyclic antidepressants are commonly used in the treatment of depression in patients with postpartum psychosis, and the minimum effective treatment is safe for mothers and infants. In cases of serious suicide attempts, use amitriptyline plus liothyronine (triiodothyronine). Haloperidol (haloperidol) and chlorpromazine have good anti- hallucination, anti-manic, delirium effects, and low toxicity. They are safe and effective antipsychotic drugs. Breastfeeding is relatively safe for breastfeeding mothers through reduced doses and careful testing of infants. Generally taking the smallest effective dose of droperidol (haloperidol) or chlorpromazine in breast milk is very small in daily average. However, when taking chlorpromazine, women should be alert to drowsiness. Lithium is the best treatment for mania.

Prognosis of postpartum psychosis

78% of patients with emotional psychosis and 30% of patients with schizophrenia behave normally after treatment, but some patients with schizophrenia have a poor prognosis.

Postpartum psychosis prevention

1. Strengthen pre-marital health

Before marriage, through various health education forms, make young people who want to marry understand sexual physiology, psychology, and sexual health; plan the correct choice of conception and contraceptive methods; take care of the health of newborns during pregnancy and the common diseases and genetic diseases that affect marriage and childbirth of men and women. Pre-marital health care has played a positive role in improving women's self-care awareness and ability in reproductive health, mastering scientific contraceptive methods for married couples, and reducing unplanned pregnancy.

2. Carry out mental health during pregnancy and childbirth

Maternal mental health care has become one of the important contents of perinatal health care. Prenatal examination should routinely include psychological guidance and counseling; pregnant women should be told what kind of psychological obstacles they may encounter during pregnancy to enable them and their families to improve cognition and identify abnormalities early; if abnormalities are found, they should be reported to the physician as soon as possible. Ask for help and cooperate well with the doctor in the treatment; pay attention to the awareness of the inducing factors, and give special intervention to pregnant women who have been screened for various risk factors for psychological disorders,

3. Popularize and promote family-based Doula delivery.

4. Promote breastfeeding

The practice of mother-to-child room and breastfeeding is the continuation of the interdependent relationship between mothers and infants. The mutual interaction, influence and role of breastfeeding babies can promote mother-to-child bonding, and cultivate early mother-to-child communication to avoid feeling cold. At present, China has launched a baby-friendly hospital and promoted breastfeeding. It has achieved good results. Continuing to protect and promote breastfeeding can help prevent postpartum depression.

5. Improve perinatal health services

With the development of new medical models, research on the health and prevention of socio-psychological factors in perinatal health care must also be included in the agenda. Perinatal health workers should have knowledge of maternal psychology and improve their skills in psychological counseling and nursing.