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Postpartum Psychosis: Understanding, Support, and Recovery

Postpartum Psychosis: Understanding, Support, and Recovery

Postpartum psychosis (PPP) is a challenging but treatable mental health condition that can affect new mothers, typically appearing within days but sometimes lingering for up to six weeks after childbirth. It can be frightening, as it may cause distorted thinking and emotions, potentially leading to actions that are out of character. However, it’s important to know that with the right support and treatment, recovery is possible. 

Remember, you are not alone in this. Many women have successfully overcome PPP with the right support and treatment. The well-being of you and your baby is of utmost importance, and seeking help is a brave and positive step towards healing. 

Who is Affected by PPP?

PPP can affect anyone who has recently given birth, but certain factors may increase the risk. Individuals with a history of mental health conditions, such as bipolar disorder, major depressive disorder, or schizophrenia spectrum conditions are more susceptible (Cleveland Clinic). Additionally, those with a family history of PPP or related mental health conditions may be at a higher risk. 

Signs and Symptoms

The symptoms of PPP can vary but often include hallucinations and delusions, which can distort a person’s sense of reality. Hallucinations and delusions are often thought to be similar and interchangeable, but they are quite different. Hallucinations involve experiencing things that aren’t real, like hearing voices or seeing things that aren’t there. On the other hand, delusions are false beliefs that are not based on reality and are often resistant to evidence or reasoning. 

  • Hallucinations: These occur when your brain acts as if it’s getting input from your senses (usually your eyes or ears, but occasionally touch hallucinations can happen, too) without any actual input. The things you see or hear feel real, but you can’t tell the difference between a hallucination and something that’s truly happening (Cleveland Clinic). 
  • Delusions: These are false beliefs that you hold onto very strongly. If you have a delusion, you hold these beliefs so strongly that you won’t change them even if you have convincing evidence that what you believe isn’t true. Examples include persecutory delusions (believing someone is out to get you), control delusions (feeling that someone else is controlling your body), or somatic delusions (insisting you didn’t have a child or weren’t pregnant) (Cleveland Clinic). 

Types of PPP

In postpartum psychosis, subtypes are different types or versions of the condition that have specific symptoms, causes, or other characteristics that set them apart, these are the three main types: 

  • Depressive Subtype: This is the most common subtype, characterized by symptoms such as anxiety, depression, guilt, loss of appetite, and thoughts of self-harm or harming the child. Research shows that depressive symptoms and psychosis are almost always a factor in cases involving self-harm or harm to a child, especially hallucinations or delusions that command a person to harm their child or themselves.  
  • Manic Subtype: Individuals with this subtype may experience agitation, talk more or faster than usual, need less sleep, and begin having delusions of greatness or importance. While the risk of self-harm or harm to children is lower compared to the depressive subtype, it is still possible. 
  • Atypical/Mixed Subtype: This subtype may exhibit a mix of manic and depressive symptoms, along with symptoms where a person appears less aware of their surroundings. Symptoms can include disordered speaking or behavior, disorientation or confusion, and inappropriate comments, behaviors, or emotional displays (Cleveland Clinic). 

Causes of PPP

The exact cause of PPP is not fully understood, but several factors may contribute to its development. These include a history of mental health conditions, the number of pregnancies (PPP is more common in first-time mothers), a family history of PPP, sleep deprivation, hormone changes, and other medical conditions that can lead to psychosis. Hormone changes, especially in estrogen and prolactin levels, are suspected to play a role in the development of PPP. 

Diagnosis and Tests

A mental health provider can diagnose PPP based on symptoms and physical exams, ruling out other conditions. Blood tests, urine tests, and imaging scans may be conducted to identify any underlying causes. However, these tests cannot diagnose PPP itself but are used to rule out other conditions or underlying causes of psychosis. 

Management and Treatment

Treatment for PPP often involves involuntary hospitalization due to the altered sense of reality it causes. Involuntary hospitalization is typically necessary because individuals with PPP are often unaware that they have a mental health or medical issue, and their altered sense of reality may make them afraid to seek help.  

Medications such as antipsychotics, mood stabilizers, or lithium may also be prescribed. In severe cases, Electroconvulsive Therapy (ECT) can be effective (Cleveland Clinic).  

Supporting Someone with PPP

Supporting someone with postpartum psychosis (PPP) is crucial for their recovery, but it can be draining and challenging. Remember to look after yourself too. Support means listening, offering practical help, and encouraging professional support. Set boundaries, prioritize self-care, and seek your support network. This ensures you can provide the best support while safeguarding your well-being. 

Here are some ways you can support someone with PPP: 

  • Support at Home: Ask trusted family or friends to stay and help with childcare. Ensure your partner rests and minimize noise. During psychosis, sit beside them for comfort, talk calmly, and keep the environment quiet. Limit their phone use and understand their reality. Don’t take their actions personally; they’re due to the illness. Call 911 or the crisis team if safety is a concern. 
  • Support during admission to the hospital: When at the hospital, ask for support, rest, and attend treatment discussions. Learn about visiting hours and help your partner settle in. Stay calm and understand the phone rules. When leaving, consider getting a ride if tired. Focus on caring for yourself and your partner, and bonding with your baby. Support your partner in bonding with the baby. Inquire about feeding support and visiting hours in a Mother and Baby Unit. In a general psychiatric hospital, ask about visitation, postpartum care, and transferring to a Mother and Baby Unit. 
  • Support to navigate the healthcare system: When your partner is admitted to the hospital, you may encounter unfamiliar terms and procedures. Remember, you know your partner best and can offer valuable insights. Ask for explanations, take time to consider options, and negotiate when possible. Seek a Mental Health Advocate if you feel unheard and use resources like APP’s forum for support and advice.
  • Support during recovery: When supporting someone living with you after hospitalization, help her settle at home by encouraging small steps in baby care, prioritizing family time, and discussing concerns together. Avoid being the ‘baby expert’ and share uncertainties. Enjoy activities together, take photos for memories, and have an emergency plan in place (AAP Network). 

Recovery

Recovery from PPP varies depending on treatment and individual factors. It’s essential to follow your trusted healthcare provider’s guidance and have a support system in place for the patient’s well-being. Supportive and understanding care from loved ones can greatly aid in the recovery process (APP Network). 

PPP is a serious condition that requires immediate attention and understanding. By raising awareness, providing support, and advocating for those affected, we can help individuals recover and promote mental health during the postpartum period. Recognizing the signs and symptoms of PPP is crucial, as it enables early intervention and reduces the risk of harm. Supportive environments and access to proper care are essential for those dealing with PPP, emphasizing the importance of community understanding and empathy. Through education and advocacy, we can create a more compassionate society that supports the mental health needs of new mothers and their families. 

 

Written by: Adiba Hussain, MPH 

Content Expertly Reviewed by: Dr. Krista Mincey, MPH, Dr.PH, MCHES 

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