This Isn't What I Expected

Notes on healing postpartum depression

Postpartum Psychosis: Scary but Treatable

You cannot afford to miss this diagnosis.

Postpartum psychosis is an extremely scary experience for new parents. It can emerge suddenly, bringing with it alarming symptoms and much confusion to all who are impacted by it. I worry terribly about the few new mothers who suffer with severe symptoms of psychosis, who might not get the help they need, or get it early enough. Often, moms with psychotic symptoms end up in an emergency room, which is a good place for them to start, since psychosis is indeed a psychiatric emergency. Unfortunately, I've seen far too many women come up against medical social workers who are not adequately informed about how psychosis presents in postpartum women. For that reason, I would like to provide some fundamental information so we can expedite a new mom's experience in the hospital.

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To Medical Social Workers in ER Settings:

Postpartum psychosis occurs in approximately 1-2 out of every 1,000 deliveries. The clinical onset is rapid, with symptoms occurring as early as the first 48 to 72 hours postpartum, although the majority of episodes develop within the first two weeks after delivery.  Postpartum psychosis is always a psychiatric emergency.

A woman with postpartum psychosis may not present with typical psychotic symptoms since she may be urgently trying to cover up her distress and return to the care of her baby.

If she is in the emergency room, it is most likely that she is experiencing either 1) acute/severe anxiety symptoms and/or 2) psychotic symptoms.

Differentiating between the two is crucial.

Therefore...

These questions should be asked of every single postpartum woman who comes to the emergency room.  The assessment should include information from family members who may be in a better position to be objective.  In addition, family members who accompany a mother to the ER should be asked to describe any behaviors they find concerning.

  • Ask her and those who are with her, the following questions:
  • Does she or anyone in her family have a history of bipolar illness or previous psychosis?
  • Is she talking or acting in a strange manner that is not characteristic for her?
  • Is she unusually quiet and withdrawn, or speaking rapidly with little concentration?
  • Does she claim to hear things or see things that others do not?
  • Is she suspicious of others or expressing concern that others are out to get her or trying to harm her in some way?
  • Does she have a decreased need for sleep or food and/or exhibit a high degree of confidence or an exaggerated sense of her capabilities or self-worth?
  • Is she abnormally hyperactive with racing thoughts and/or behaviors?

IMPORTANT POINTS TO KEEP IN MIND

New mothers may be frightened and overwhelmed. HOW the questions are asked is as important as what the questions are. "I know this may be overwhelming right now, but sometimes we see mothers here who tell they are hearing unusual voices in their head or other people may be telling them that they aren't making sense. Are you experiencing anything like this? Do you feel like there is anything unusual about the way you are feeling or acting right now?"

There is a 5 percent infanticide or suicide rate associated with postpartum psychosis.

During the psychotic state, delusions may take many forms and may not appear to be destructive. However, there is always a great risk of danger because the delusional and irrational thinking will impair her judgment and ability to care for herself and her baby.

You cannot assume that if she looks good, she is fine. Postpartum women are exceptionally good at holding it together and saying all the right things, in order to maintain control and put forth this illusion that they are fine.  The key for early intervention is to rule out psychosis with the above assessment questions when evaluating a woman in the emergency room who has recently given birth.

 

copyright 2012  Karen Kleiman, LCSW  postpartumstress.com

Karen Kleiman is founder and director of The Postpartum Stress Center, a treatment and training center for prenatal and postpartum mood and anxiety disorders. more...

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