Postpartum Psychosis What Happens When the Bough Breaks A Case Presentation

Background: Postpartum psychosis is the most severe type of postpartum psychiatric illness. It can occur as early as 2-3 days after delivery, but more commonly in the first 2-4 weeks postpartum. The incidence of postpartum psychosis is 1-2 per 1000 women. Risk factors identified are history of bipolar illness or depression, family history of mental illness, sleep deprivation,stress, poor support systems and low self esteem. Early diagnosis and treatment is crucial for obtaining a positive outcome for both mother and infant.

Case: A 42 year old, G7P3 was admitted at 41 weeks for a stat C/Section for fetal distress. A previous history of depression and two other psychotic episodes existed. The patient had a 9lb healthy infant daughter, who she was breast feeding. The husband stayed with his wife and daughter and other children visited. On day three, the patient walked out of the bathroom with a blank stare, got into bed and started a rocking movement, clutched blankets to her chest and sang out loudly church hymns. The patient would not respond to name and would not eat or drink. At one point, the patient cried that the voices were telling her to kill her infant. A Psychiatric consult was done immediately. Stat Head Cat Scan, metabolic profile, TSH, RPR and 1:1 sitters were ordered. Anti agitation meds were ordered PRN.Results of above tests were normal. A multidiciplinary team of social work, psychiatry, nursing, OB physicians and pastoral care worked to address this patient's symptoms and needs.Six days post C/S, the patient was transferred to a private inpatient psychiatric facility for two weeks. The patient then was treated as an outpatient with regular office visits.

Conclusion: Early identification and treatment of Postpartum psychosis is imperative to the well being of the mother and also her ability to care for her infant and resume her normal activities of daily living. Early and excellent nursing intervention and care played the most important part in ensuing this patient's return to a productive role as a wife and mother!

Keywords: Postpartum psychosis