Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby. Many women will experience mild mood changes after having a baby, known as the "baby blues". This is normal and usually only lasts for a few days. But postpartum psychosis is very different from the "baby blues". It's a serious mental illness and should be treated as a medical emergency. It's sometimes called puerperal psychosis or postnatal psychosis. Symptoms of postpartum psychosis Symptoms usually start suddenly within the first two weeks after giving birth. More rarely, they can develop several weeks after the baby is born. Symptoms can include: hallucinations delusions – thoughts or beliefs that are unlikely to be true a manic mood – talking and thinking too much or too quickly, feeling "high" or "on top of the world" a low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping loss of inhibitions feeling suspicious or fearful restlessness feeling very confused behaving in a way that's out of character

1. POSTPARTUM PSYCHOSIS
DR ALKA MUKHERJEE
DR APURVA MUKHERJEE
NAGPUR M.S. INDIA

2. DR ALKA MUKHERJEE
MBBS DGO FICOG FICMCH PGDCR PGDMLS MA(PSY)
Director & Consultant At Mukherjee Multispecialty Hospital
MMC ACCREDITATED SPEAKER
MMC OBSERVER MMC MAO – 01017 / 2016
Present Position
 Director of Mukherjee Multispecialty Hospital
 Hon.Secretary INTERNATIONAL COUNCIL FOR HUMAN RIGHTS
 Hon.Secretary NARCHI NAGPUR CHAPTER (2018-2020)
 Hon.Secretary AMWN (2018-2021)
 Hon.Secretary ISOPARB (2019-2021)
 Life member, IMA, NOGS, NARCHI, AMWN & Menopause
Society, India, Indian medico-legal & ethics association(IMLEA),
ISOPRB, HUMAN RIGHTS
 Founder Member of South Rapid Action Group, Nagpur.
 On Board of Super Specialty, GMC, IGGMC, AIIMS Nagpur,
NKPSIMS, ESIS and Treasury, Nagpur for “ WOMEN SEXUAL
HARASSMENT COMMITTEE.”
mukherjeehospital@yahoo.com
www.mukherjeehospital.com
https://www.facebook.com/
Mukherjee Multispeciality
https://www.instagram.com/
Achievement
 Winner of NOGS GOLD MEDAL – 2017-18
 Winner of BEST COUPLE AWARD in Social
Work - 2014
 APPRECIATION Award IMA - MS
 Past Position
 Organizing joint secretary ENDO-GYN
2019
 Vice President IMA Nagpur (2017-2018)
Vice President of NOGS(2016-2017)
Organizing joint secretary ENDO-GYN
Organizing secretary AMWICON – 2019

3. DEFINATION
• Postpartum psychosis is a severe mental illness characterized
by extreme difficulty in responding emotionally to a
newborn baby — it can even include thoughts of harming
the child.
• Different from postpartum depression,
• “It usually represents a bipolar disorder, not just a
depressive disorder,"
• Postpartum psychosis as a "psychiatric emergency," because
of the potential for harm to the baby or the new mother.
• Postpartum psychosis - severest form of mental illness -
characterized by extreme confusion, loss of touch with
reality, paranoia, delusions, disorganized thought process,
and hallucinations

4. • Childbirth - major physical, emotional, and social stressor in
a woman’s life.
• Mood swings and mild depression ( post-baby blues), PTSD,
major depression, or even full-blown psychosis
• Several bio-psycho-social factors - physical and hormonal
changes, lack of sleep and exhaustion, and the beginning of
a new role and commitment in caring for a newborn (both
physically and emotionally challenging)
• Affects around one to two per one thousand females of
childbearing age within days to the first six weeks after
birth.
• Psychiatric emergency - immediate medical and psychiatric
attention and hospitalization if the risk of suicide or filicide
exists.

5. ETIOLOGY: COMPLEX MULTIFACTORIAL ORIGIN
• A history of bipolar disorder,
• History of postpartum psychosis in a previous pregnancy,
• Family history of psychosis or bipolar disorder,
• History of schizoaffective disorder or schizophrenia and
discontinuation of psychiatric medications during pregnancy.
• Prevalence is higher in patients suffering from affective
disorders like bipolar one, two, and first-time pregnancy with a
previous family or personal history of bipolar disorder
• Lack of sleep
• Hormonal fluctuations after birth - rapidly falling levels of
estrogen,
• Sleep loss triggering episodes of mania

7. History and Physical
• A careful and thorough history and neuropsychiatric evaluation
• Rule out a previous personal or family history of psychiatric
illness.
• Evaluate or rule out medical comorbidities, organic causes, and a
complicated obstetrical history like preeclampsia and eclampsia or
negative birth outcomes.
• Note whether the patient with a psychiatric history who was
previously stable on psychiatric medications/ medicines
withdrawn in pregnancy
• Substance abuse, medication history, and a history of any other
recent major stressors or traumatic events
• Evaluate the patient’s social support network, including the role
and responsibilities of her partner and other available caregivers
in the family.

9. Symptoms of
puerperal psychosis
• Confusion,
• Lack of touch with reality,
• Disorganized thought pattern and
behavior,
• Odd effect,
• Sleep disturbances,
• Delusions,
• Paranoia,
• Appetite disturbances,
• A noticeable change in the level of
functioning from baseline,
• Hallucinations and
• Suicidal or homicidal ideation.
• Safety of the patient and newborn is
of utmost importance - immediate
hospitalization

11. Evaluation- underdiagnosed and underreported
• No standard screening procedures in place during the
prenatal and postnatal period.
• A thorough history and complete physical examination
•Creatinine
•Vitamin B12
•Folate
•Thiamine
•Thyroid function tests
•Liver function tests or LFTs
•Urinalysis
•Urine drug screen
•Urine/blood cultures for patients
•with fever
•CT/ MRI brain
Lab work-up:
•A complete blood count(CBC)
•Electrolytes
•Blood urea nitrogen (BUN)
•Blood glucose
•Creatinine
•Vitamin B12
•Folate
•Calcium
•Blood glucose

12. Differential diagnosis
•Vitamin B12 deficiency
•Thiamine deficiency
•Hypercalcemia
•Pregnancy-induced hypertension and
stroke due to preeclampsia or eclampsia
(CT/MRI to rule out stroke)
•Metabolic or nutritional causes
(electrolytes)
•Immunological causes like SLE
•Certain drugs like corticosteroids,
antivirals (acyclovir and interferon),
antibiotics (gentamicin, vancomycin,
isoniazid), anticholinergic medicines like
atropine, benztropine, and
sympathomimetic stimulants like
amphetamine, ephedrine, and
theophylline
•Bipolar 1 relapse (current and past history of
low and high moods plus family history)
•Unipolar major depression with psychotic
features with postpartum onset
•OCD and schizophrenia or schizophreniform
disorder (past treatment history and
medication non-compliance)
• fever due to these conditions: infections such
as sepsis, meningitis, encephalitis, (complete
blood count/ESR /differential, lumbar
puncture)
•Substance misuse (drug screen for drugs of
abuse)
•Uremia (kidney function tests, BUN,
creatinine)
•Hepatic encephalopathy (LFTs, AST, ALT,
hepatitis screen if a history of exposure or
disease, alkaline phosphatase, bilirubin
direct/indirect, lipase)

14. Treatment for postpartum psychosis
• Timely identification of the illness
• Postpartum psychosis usually has a sudden onset but is a
brief and limited illness which responds rapidly to
treatment.
• Hospitalization
• Rule out organic causes
• Antipsychotic medications
• Antidepressants
• Electroconvulsive therapy (ECT)
• Counseling with a psychiatrist, psychologist, or other
qualified mental health professional

15. • Lithium - standard treatment option for bipolar depression and
postpartum right after delivery in patients with a history of
bipolar disorder or previous isolated episodes of postpartum
psychosis.
• Use of lithium during pregnancy is controversial - significant risk
for congenital malformations EG. Ebstein anomaly and low fetal
birth weight
• For women with a previous history of postpartum psychosis, the
recommendation - high therapeutic target level lithium
prophylaxis (zero points eight to one mmol/liter) to prevent future
episodes. (lithium blood levels should be obtained twice a week
for at least the first two weeks postpartum.)
• Women should abstain from breastfeeding - as it is eliminated in
breast milk - higher exposure levels in infants as their metabolic
systems and mechanisms of drug excretion are underdeveloped.

16. • SSRIs, carbamazepine, sodium valproate, and short-acting
benzodiazepine - relatively safe during breastfeeding. Not
only does breastfeeding lead to lack of sleep and exhaustion
to the mother - further exaggerate her symptoms
• Oxytocin also causes insomnia in breastfeeding mothers.
• Patients with a history of bipolar disorder stable on mood
stabilizer medications before pregnancy who discontinue
medications during pregnancy - elevated risk of developing a
relapse in the perinatal or postnatal period.
• medications used as maintenance therapy - pose a risk of
congenital malformations and other neural complications

17. Electroconvulsive therapy (ECT)
• Electroconvulsive therapy (ECT) is recognized as a means of
treatment with a tremendous benefit in patients with
psychosis related to schizophrenia and
schizoaffective disorder refractory to antipsychotic
pharmacotherapy.
• ECT is also considered a safe and effective intervention in
patients with acute relapse or exacerbation of psychosis in
the postpartum period with the risk of minimal
complications.

18. • The patient and the family must make an informed decision,
carefully weighing the risks and benefits of medication
management during pregnancy.
• Major congenital malformations - Lithium - 2.8%
Valproate 5 to 8%, and
Carbamazepine 2 to 6%.
Atypical and typical antipsychotics - the risk unclear.
Non-pharmacologic treatment - psychotherapy is a good
Adjuvant treatment - safe and effective means of treating an
Acute episode during pregnancy alongside or without
Psychiatric medications

19. PROGNOSIS
• Having one episode of postpartum psychosis predisposes the
patient to another episode with a future pregnancy.
• Patients with a history of bipolar disorder are predisposed to
developing a relapse during and after pregnancy and should
be carefully evaluated and counseled regarding the risk in
future pregnancies.

20. Complications
Rare occurrence
May lead to undesirable outcomes.
The proper identification of risk markers would enhance the
Ability to prevent and manage the condition.
Suicide or filicide.
Tremendous stress for the partner and other family members