);

Understanding Postnatal Psychosis: What is it and what help is available?

What is Postnatal Psychosis?

Postnatal Psychosis (PP), also known as postpartum or puerperal psychosis, is a serious condition that affects a woman’s mood, thoughts and behaviour. PP typically occurs within the first four weeks post-birth, however can occur up to 12 weeks postpartum. PP affects approximately 1-2 in every 1,000 mothers (0.10-0.20%), making it far less common than other perinatal mental health conditions such as depression and anxiety.

Women who experience PP may be at risk of harming themselves or others, including their baby or other children. This is one of the reasons why it is so important to raise awareness about PP, so that it can be identified early with appropriate assistance sought urgently. Currently, the cause of PP is not known. Available evidence indicates that women with a history of bipolar disorder have a greater risk of developing PP. Women who have previously experienced PP are also more likely to have a recurrence with future births. A small number of women with no previous psychiatric history will also experience the condition. Intense sleep deprivation and hormonal changes are believed to be contributing factors. Being aware of the symptoms of PP and seeking professional support as early as possible is critical in minimising the impact of the condition and facilitating a full recovery.  

Symptoms of Postnatal Psychosis

The symptoms of PP are fairly distinct from those of other perinatal mental health disorders. While they include some depressive symptoms (similar to those seen in perinatal depression), what defines PP is the very noticeable presence of manic and psychotic symptoms. Postnatal psychosis causes a ‘disconnect’ with reality, resulting in behaviour that is clearly uncharacteristic of the individual and is obviously ‘unusual’. Postnatal psychosis can cause sudden and dramatic changes to a woman’s thoughts, mood, behaviour and perception. Symptoms can vary from one individual to the next however the core symptoms of PP include:

Changes in behaviour

  • Rapid and erratic speech, often not finishing sentences
  • Disorganised behaviour, often appearing confused and forgetful
  • Making lots of unrealistic plans
  • Impulsive behaviour (e.g., overspending)
  • Getting into arguments
  • Difficulty coping with regular activities such as caring for the baby/children, managing household tasks
  • Withdrawing from other people
  • Aggressive and/or violent behaviour

Changes in mood

  • Extreme and sudden mood swings (from very high to very low and vice versa)
  • Presence of persistently depressed or elevated/excitable mood
  • Intense feelings of hopeless, helplessness and worthlessness, especially in regards to one’s role and capacity as a mother

 Changes in energy levels, sleeping and eating patterns

  • Feeling ‘full of energy’ or restless
  • Feeling agitated and unable to sit still
  • Feeling an intense need to ‘get things done’
  • Reduced need for sleep
  • A sense of being ‘unable’ to sleep and eat

Changes in thoughts and perception

  • Feeling powerful and invincible, almost like a ‘superhero’
  • Hearing voices or seeing things that aren’t really there (hallucinations)
  • Having unusual thoughts and beliefs (delusions). Often these will include beliefs that:
    • someone is trying to harm the baby
    • she should be punished for being a bad person/mother, or that
    • she or her baby have some type of special powers
  • High mood with loss of touch of reality (mania)
  • Recurring thoughts about death and/or a sense of ‘wanting’ to die
  • Thoughts of harming oneself and/or the baby
  • Difficulty concentrating and/or severe confusion
  • Being highly suspicious of others

If you notice any of these symptoms in your partner or loved one who has recently given birth, you should seek professional assistance immediately. Postnatal psychosis is considered a medical emergency due to the nature of the thoughts and impulsive behaviour women may experience.

Treatment and Support Options

So, what does treatment look like for such a serious condition? In most, if not all, cases of PP recognising the need for and engaging professional assistance will need to be actioned by the woman’s partner and/or close family/friends. This is undoubtedly a difficult decision and course of action for loved ones to take. Partners and family/friends will usually also have to organise suitable care for the baby and/or other children. If you are concerned about a loved one’s safety, it is important that someone stays with her until help is sought. Depending on the situation you may:

  • Take her to a GP
  • Take her to the nearest hospital emergency department
  • Call 000 for an ambulance (if there is concern about immediate safety).

When speaking to emergency or health care staff it is important that you explain the situation, including the unusual or concerning behaviour you have noticed, and that you think she is experiencing postnatal psychosis.

Women with PP will almost always require admission to a hospital with a psychiatric service. This allows the woman to be assessed and monitored by health professionals in a safe environment. Some hospitals have specialised wards known as Mother and Baby Units (MBU’s), where babies can stay with their mother. This provides an opportunity for the mother to remain close to her baby and encourages ongoing contact and care between them. This may not be appropriate for women who are severely unwell and/or incapable of caring for their baby, or when there are concerns for the safety of the baby.

Staff in a MBU will often provide a lot of care for the baby in the first few days to allow the mother an opportunity to rest. A thorough mental health assessment will be conducted in an effort to determine an appropriate treatment plan. While treatment can vary, medication will almost always be required. Individual therapy with a psychiatrist and/or a psychologist is also usually part of the treatment process. Group therapy sessions with other women are also often conducted within MBU’s. Many women find the support from other mums in the unit to be really helpful. Nursing staff will also continue to help women care for their baby in an effort to increase their confidence in their skills as a mother. The length of time a woman remains in hospital will vary depending on the individual and response to treatment. In cases of particularly severe PP, electroconvulsive therapy (ECT) may be recommended by a psychiatrist. This is only conducted in a hospital setting, under close supervision.

It is important to note that access to a MBU largely depends on location as there are a limited number of MBU’s across Australia (i.e., unfortunately currently there are no MBU’s in NSW). Most MBUs also have waiting lists and require a referral from a health professional (for example, a GP). Given that an admission to a specialised MBU may not always be possible, in many cases a woman will need to stay, at least initially, in a general adult psychiatric ward. In these cases, the mother is admitted by herself and so her baby will need to be cared for by her partner or a friend/family member (to find out more information about MBU’s in your local area and what is required to be admitted into one, please speak to a health professional).

Following discharge from hospital, ongoing support and monitoring of both the mother and baby is required from a specialist mental health professional (e.g., psychiatrist and/or psychologist) to ensure that the woman remains well and is able to care for her baby. In most instances, women will need to be supported and monitored daily, with partners, family, friends and health professionals all playing an important role during the recovery process.

Undoubtedly, seeing a partner or loved one experience PP can be a difficult and times frightening experience; however it is important to remember that it is a condition that women recover from. Ongoing support is essential; given the relatively low prevalence rates it can be difficult for women to connect with others who have had a similar experience, particularly if there were limited opportunities to do so in hospital. ‘Beyond PP’ is an online Facebook group created by women who have experienced PP and allows women and families who have been affected by PP and to reach out and share stories, information and experiences (see link below). https://www.facebook.com/login/?next=https%3A%2F%2Fwww.facebook.com%2Fgroups%2F473249929541274%2F

Summary:

Postnatal psychosis is a serious and complex mental health condition that requires specialist treatment and care. PP can cause intense changes to a woman’s thoughts, behaviour and sense of reality. Once identified, a woman will usually be admitted to hospital where she will be assessed and commence treatment; this is likely to involve medication as well as psychotherapy. Ongoing support from health professionals, partners, family and friends is crucial in the recovery process. Given the impact that PP can have on a mother, her infant, other children, partner and loved ones early identification and treatment is essential. If someone you care about doesn’t ‘seem like themselves’ and you are concerned about their wellbeing or safety, reach out and speak up. As scary as PP can be, effective treatment and support is available.

References and sources for additional information:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Washington, DC: Author.
  • Australian Psychological Society: EQIP (2015). Perinatal Depression Guide for Practitioners
  • Austin M-P., Highet N., and the Expert Working Group (2017). Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence.
  • (2011). Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: The national depression initiative.
  • Beyondblue (2012).Managing mental health conditions during pregnancy and early parenthood: A guide for women and their families
  • COPE: Postpartum psychosis factsheet:

 file:///C:/Users/G/Downloads/Postpartum-Psychosis_Consumer-Fact-Sheet.pdf

 Written by Dr Sofia Rallis

Disclaimer:

Please note that the information provided in this article, and any associated references, is general and is not intended to be therapeutic in nature. If you feel that you would benefit from additional support and/or require urgent assistance please contact your GP, or one of the following services in your state.

Crisis and Support Services
National Services:
Lifeline
13 11 14 (24 hours a day, 7 days a week)
www.lifeline.org.au

Perinatal Anxiety and Depression Australia (PANDA)
1300 726 306 (Monday-Friday 9am – 7.30pm (AEST / ADST)
www.panda.org.au

Pregnancy, Birth and Baby Helpline
1800 882 436
https://www.pregnancybirthbaby.org.au

MensLine
1300 78 99 78
www.mensline.org.au

 Suicide Call Back Service
1300 659 467 (24 hours a day, 7 days a week)
www.suicidecallbackservice.org.au

 Centre for Perinatal Psychology (National Centre of Perinatal Psychologists)
1300 852 660
https://www.centreforperinatalpsychology.com.au/

 

Additional State Based Services:
Victoria:
Maternal and Child Health Line 24 hours a day, 7 days a week 13 22 29
Parentline VIC 8am to 12am Monday to Friday, 10am to 10pm weekends 13 22 89

NEW SOUTH WALES:
Karitane Careline 24 hours a day, 7 days a week 1300 227 464
Parentline NSW 24 hours a day, 7 days a week 1300 130 052

ACT:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parentline ACT 9am – 9om Monday to Friday (except public holidays) (02) 6287 3833

QUEENSLAND:
Child Health Line 24 hours a day, 7 days a week 13 43 25 84
Parentline QLD & NT 8am to 10pm, seven days a week 1300 30 1300

SOUTH AUSTRALIA:
Child and Youth Health Service 9am – 4.30pm Monday to Friday 1300 733 606
Parent Helpline SA 24 hours a day, seven days a week 1300 364 100

WESTERN AUSTRALIA:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parent Help Centre WA 24 hours a day, 7 days a week 1800 654 432

NORTHERN TERRITORY:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parentline QLD & NT 8am to 10pm, seven days a week 1300 30 1300

TASMANIA:
Parenting Line TAS 24 hours a day, 7 days a week 1300 808 178