British Columbia Reproductive Mental Health Program

Reproductive Mental Health

bullet.gif (1642 bytes) Psychosis

Incidence of women who experience Psychosis during pregnancy.

Psychoses arising for the first time in pregnancy is very uncommon. Women who have a past history of a psychotic illness (like Schizophrenia and Bipolar Disorder) may become pregnant and may need to be maintained on medication during pregnancy.

Incidence of women who experience Postpartum Psychosis.

Between 1-2 women per 1,000 births experience a Postpartum Psychosis This is also a rare occurrence, but if psychosis occurs it is most likely to occur during the postpartum period rather than during pregnancy.

What is Psychosis?

Psychosis is a condition occurring in the context of an underlying psychiatric disorder like: Bipolar Affective Disorder, Schizophrenia, or Major Depression. For some women, a Postpartum Psychosis may be the only psychotic episode they will experience. For others, a Postpartum Psychosis may be the first episode of a psychiatric disorder or an acute exacerbation of an underlying disorder.

During a psychotic episode, the woman losses touch with reality. The woman may be:

  • hallucinating e.g. hearing voices when nobody is around or may be
  • delusional - having ideas that she believes despite all proof that they are false, e.g. convinced that someone is trying to harm her, or that her baby is the devil.
  • thought disordered-her thought process may be illogical or chaotic.

It can be a very frightening condition and needs immediate treatment. Postpartum Psychosis occurs usually within two to four weeks after delivery.

Risk Factors of Psychosis

Women are at greater risk of having a Psychotic experience if they have a:

  • Previous history of Postpartum Psychosis (having a previous episode of Postpartum Psychosis increases your risk by 50% with a subsequent pregnancy)
  • Previous history of Bipolar Mood Disorder or Schizophrenia
  • Family history of Bipolar Mood Disorder or Schizophrenia

Signs and Symptoms experienced by women with Psychosis

You may experience some of the following:

  • disturbed sleep
  • emotional lability
  • confusion and disorientation
  • disorganized thoughts and behavior
  • hallucinations (hearing voices when there is no one there)
  • delusions (thinking that people are trying to harm you or that you have special powers)
  • usually occurs within 2-4 weeks after delivery, but may occur within the first three months after delivery.

Reasons why pregnant or Postpartum women having a Psychotic experience should seek treatment.

Women experiencing a psychosis are at risk of committing suicide and, in very rare cases, of harming their unborn child or infants. These women need to be hospitalized for their safety and to safeguard their infants.

This is a psychiatric emergency and the woman needs to be hospitalized immediately. Because of her confusion the woman may not have the insight to recognize how ill she is, therefore, the decision for hospitalization will be made by her physician.

Ideally women should not be separated from their babies during hospitalization. We would recommend special mother-baby units or designated beds on maternity wards where the baby could be assigned to the nursery and supervised by neonatal nurses.

Treatments Options for women with Post Partum Psychosis.

  1. Biological Approach - Rule out medical conditions that may present as psychosis (e.g. infection, seizure disorder, electrolyte disturbance). Antipsychotic medication, Mood Stabilizing medication
  2. Psychological Approach - Interpersonal Therapy Supportive -Psychotherapy (individual or group) Couple Counseling
  3. Social Approach - Psychoeducation Involve the significant other, friends and family supports. Teach the building of social networks and supports. Supportive Housing

See also:

"Use of Antipsychotic Medication in Pregnancy & Postpartum."

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