G’s husband entered my consultation room looking worried and distressed. “Doc, I need you help urgently,” he said. "You just delivered my son a week ago. My wife was well in the hospital except for a few episodes of what I thought were “baby blues”. When she was back at home, she could not sleep at night and would roam about in the room feeling high and singing loudly to the baby, even though the baby is asleep. She has also become increasingly irritable and lashes out at everyone close to her. Her behaviour has gone erratic and weird. Last night, she told me that somebody in the hospital had swapped her baby. She could hear voices telling her that our neighbour was plotting to kill her. I am at my wits' end and feel really helpless and desperate. What shall I do now?”
G is suffering from a rare but serious mental health illness called postpartum psychosis. It is much less common than baby blues or postnatal depression and occurs in about 1 in every 1000 women (0.1%) who has delivered.
Patients with this condition usually have symptoms which start suddenly within the first two weeks after giving birth. Occasionally, the illness may start several weeks after the baby is born.
Symptoms vary and can change rapidly. They include:
Hallucinations: These are sensations that appear to be real but are created within the mind. E.g. hearing voices which are not there.
Delusions: These are thoughts or beliefs that are unlikely to be true.High mood (mania), feeling “high” and low mood, with signs of depression
Restlessness and confusion
Causes of postpartum psychosis are not well understood. But there are several risk factors, including family history and genetic factors. Hormone levels and disturbed sleep patterns may also be involved. Mothers with a history of a traumatic birth or pregnancy, bipolar disorder or schizophrenia are also more vulnerable.
As postpartum psychosis is a serious illness, I referred G to the psychiatrist, who admitted her immediately to the hospital and started medical treatment with antipsychotic drugs and mood stabiliser. G’s condition improved slowly with medications and behavioural therapy and was discharged from the hospital after 2 weeks. She looked well when I saw her 6 weeks later. She still occasionally felt depressed and anxious with little social confidence. With a strong family support, G has fully recovered from the illness 8 months after her delivery.