FORENSIC MEDICINE (POSTPARTUM PSYCHOSIS )

1. POSTPARTUM PSYCHOSIS

2. POSTPARTUM PSYCHIATRIC
DISORDERS
• POSTPARTUM PERIOD OR PUERPERIUM PERIOD :
Period of about six weeks after child birth during
which the mother’s reproductive organ return to
their original non – pregnant condition .
• PSYCHIATRY : It is that branch of medical science ,
which deals with the study , diagnosis , treatment
and prevention of mental illness and behavioral
disorders .

3. POSTPARTUM PSYCHIATRIC
DISORDERS
TYPES
1) POSTNATAL BLUES – Mild depression and
irritability .
2) POSTPARTUM PSYCHOSIS – Severe
psychiatric symptoms including depressive
episodes , schizophrenia , manic episodes or
delirium .

4. POSTPARTUM PSYCHOSIS
• Postpartum psychosis ( puerperal psychosis or
postnatal psychosis ) is an acute mental
disorder or a psychotic reaction occurring in a
woman following childbirth or abortion .
• The postpartum psychotic woman usually
develops symptoms within the first 2 -3 weeks
after delivery .

5. EPIDEMIOLOGY
INCIDENCE
• More common in primiparous than
multiparous women .
• Occurs in less than 1 or 2 per 1000 deliveries .
ONSET
• Abrupt , especially within about 3 to 10 days
after delivery or 3 to several weeks after
delivery .

6. AETIOLOGY
• The precise cause is unknown . However ,the following serve
as risk factors :
1. Genetic / Hereditary
2. Hormonal changes e.g Oestrogen , progesterone etc .
3. Family or personal h/o mental illness .
4. Substance abuse
5. Lack of social and emotional support , Death of loved ones ,
Low self esteem , poor marital relationship , childcare stress ,
Infant temperament problems etc
6. Unwanted or Unplanned pregnancy.
7. Financial problems , Low socioeconomic status .

7. ORGANIC CAUSES
• Ischaemic or Haemorrhagic stroke
• Hyponatraemia / Hypernatraemia ,
Hypogylcemia / hyperglycemia etc .
• Thyroid or parathyroid abnormalities
• Vitamin B12 , Folate or Thiamine deficiencies
• Side effects of medication
• Sepsis

8. SIGNS AND SYMPTOMS
• Hallucinations : e.g auditory –commanding the patient
to kill the baby .
• Delusions : e.g baby is messiah or embodiment of evil .
• Insomnia
• Depersonalisation
• Crying spells
• Agitation / feeling of anxiety
• Feeling of resentment
• Feeling of inadequacy
• Feeling misrecognition
• Mood disturbances e.g manic or depressive .

9. COMPLICATIONS
• Suicide
• Infanticide
• Homicidal thoughts
• Lack of normal mother-infant bond .
• Marital or family problems

10. MANAGEMENT
• Rapid hospitalisation if she is thought to pose
a threat to baby , herself or others .
• Medication / pharmacotherapy :
a)Antipsychotic drugs
b) Antidepressants
c) Antianxiety drugs
• Psycological counselling i.e. psycotherapy
• Education for mother and family

11. BREASTFEEDING
• Breastfeeding is contraindicated in case of
puerperal psychosis as most of antipsychotics
are excreted in breastmilk.
• Mothers on lithium treatment should be
encouraged not to breast feed due to
potential toxicity in infants .
• Baby should be monitored for side effects in
case of prescribed breastfeeding women.

12. STAY HOME AND BE SAFE !!
THANK YOU