Causes of Post partum psychosis



Epidemiology

  • 1 in 500 to 1 in 1000 deliveries
  • risk of recurrence following first episode=30% to 50% with each subsequent pregnancy
  • 50% - 80% chance of developing another episode at any point, usually within bipolar spectrum

Risk factors for PP

  • Known case of Bipolar Mood disorder
  • personal or family history of PP
  • Screen at-risk population and offer treatment prophylaxis before delivery to avoid illness

Symptoms to recognize

  • mood swings
  • confusion
  • strange beliefs
  • hallucinations
  • especially in the first 2–4 weeks postchildbirth

Red flags

  • Confusion
  • threats to harm herself or others
  • difficulty caring for her children
  • poor self-care

Clinical Features

  • Mania or depression, mixed mood + psychosis or non affective psychosis (<10%) Confusion
  • Disorganized behaviour
  • Obsessive thoughts, delusions, hallucinations - may be in relation to the infant, delusions may be mood incongruent
  • Notable perplexity
  • Marked fluctuations in intensity of symptoms
  • Suicidality, homicidality - "altruistic homicide"
  • Always enquire re thoughts of harm to self and/or infant/other children

Screening tools

  • Depression - EPDS
  • Mania / Hypomania - MDQ

In infected, medically ill patients, cytokine-driven sickness behavior, psychological reaction, delirium, and medication side effects must be differentiated

aminoglycoside with broad antimicrobial activity, is commonly used in both obstetrics and gynecology

Are used for Respiratory infection and UTI in non-pregnant women. Cat D drug near term

Used as part of anti-tuberculous treamtent. Well documented s/e. .case report

used for treatment of sepsis along with other antibiotics

CNS side effects of levofloxacin like headache, dizziness, restlessness, tremor, insomnia, hallucinations, convulsions, anxiety and depression are well documenteds..case report

used for treatment of sepsis along with other antibiotics

used for Rx of Herpes Simplex Virus infection, Genital Herpes

May be used for treatment of hepatitis C virus infection or melanoma. Induces depressive symptoms in up to 58% of patients

Neurologic, rheumatologic, GI, respiratory, oncologic illnesses. Symptoms may vary from subtle anxiety/depression to full-blown affective and psychotic syndromes. Dose-dependent

Dopamine agonist. Used for the prevention of breast engorgment.

Benzodiazepines ? reports and small studies report association with depression and even suicide. Associated with higher doses and lower anxiety

Classic signs and symtpoms of sympathomimetic toxidrome hyperactivity, mydriasis (dilated pupil), hypertension, tachycardia, hyperthermia, may also ppt psychosis and seizures.

Anti-Asthamatic.

Used in spinal anaesthesia to prevent low BP and as an anti-asthamatic.

Decongestant used to relieve stuffy nose.

mad as a hatter (Psychosis), hot as hell (Hyperthermia), red as a beat (flushed skin), dry as a bone (dry mouth and urinary retention), and blind as a bat (dilated pupils)

antihistamine used to relieve symptoms of allergy, hay fever, and the common cold.

Opioid agonist used for analgesia. Obstetric analgesia is also an indication. case report

Acute: agitation, paranoia, hallucinations, hyperthermia. Chronic: cognitive impairment, suicidal ideation or attempt

Similar to cocaine; CNS excitation, hyperthermia, seizures, hypertension, tachycardia

Muscarinic and nicotinic signs, CNS toxicity, and cardiac arrhythmias

Anxiety, tachycardia, mydriasis, nausea, flushing, tactile hallucinations, anhedonia, CNS dysfunction, chest pain, pyrexia

Same as cocaine, both may have a chronic phase as well

Agitation, autonomic instability, insomnia, seizures, and delirium tremens

Head and face edema, Headache, Visual distrubance, Excessive wt gain, Increased BP. pre-eclampsia, eclampsia

Careful medical history, with history of severe headache, preeclampsia during pregnancy, unilateral weakness, new onset sensory deficits, seizurelike behaviors; check blood pressure; consider head CT or MRI; consult neurologist urgently

Ischemic stroke (arterial or venous) secondary to preeclampsia or eclampsia, severe hemorrhage during delivery more

Hemorrhagic stroke secondary to uncontrolled hypertension, arteriovenous malformation, aneurysm, disseminated intravascular coagulation more

Wacky, Wobbly and Wet. more

Repeated seizures without a causative factor. Seizures may be followed by a post-ictal period of depression or psychosis.more

Fever and chills or Very low body temperature, Rapid pulse, Rapid breathing. more

Headache, Nuchal rigitity, Fever, Nausea, Vomiting, Altered LOC, Focal deficits, Seizures. more

90% are women, more common in Asians and blacks. Photosensitivity, discoid or malar rash, oral ulcers; fatigue, weight loss, fevers; arthralgias and arthritis; pleuritis, pericarditis; renal disease; anemia, leucopenia. more

Lupus cerebritis likely to occur in post partum period

Acute or subacute mood/behavioral changes, short-term memory problems, complex-partial seizures, cognitive dysfunction. Also hyperthermia, somnolence, and endocrine abnormalities. Most common associated malignancies ? lung (small cell carcinoma; SCC), testicular, breast, ovarian, thymoma, Hodgkin lymphoma. Or there may be no malignancy [i.e. non-neoplastic]. more, case report - LE presenting as PP

Hyponatremia - Serum Na less than 124 - Nausea, Vomiting, Headache, Lethargy. Serum Na less than 120 - Confusion, Ataxia, Seizures, Coma. more

Hypernatremia - Nausea, Vomiting, Anorexia, Lethargy, Hyperreflexia, Seizures. more

Likely in a patient rxed with Mag Sulf. First sign - loss of tendon reflexes. other early signs flushing, feeling of warmth, double vision, somnolence, slurred speech, weakness and hypotension. Later symmptoms muscular paralysis and respiratory depression. magnesium sulfate, hypermagnesemia

Sympathetic symptoms - Sweating, Tremor, Tachycardia, Anxiety, Hunger.

Neurologic symptoms - Dizziness, Visual disturbance, Confusion, Loss of consciousness, Convulsions, Syncope. more

Polyuria, polydipsia, polyphagia, Abdo pain, Nausea, Vomiting, Fatigue. more

Fatigue, Anorexia, Nausea or Vomiting, Weight gain, Edema, Confusion (uremic encephalopathy). more

Early - day night reversal, sleepiness, confusion, personlaity change, flapping tremor.

Later - fetor hepaticus, stupor, seizure, coma. more

The time frame for postpartum (painless/lymphocytic) thyroiditis, which is characterized by transient hyper- and hypothyroid phases, may overlap with that for postpartum depression,although there is no established causal relationship between the 2 conditions.

Weakness, fatigue, somnolence, cold intolerance, weight gain, constipation, hair loss, hoarseness, stiffness, muscle aches, bradycardia, facial puffiness, slowed speech. more

Symptoms include nervousness, anxiety, irritability, sweating, fatigue, heat intolerance, weight loss, muscle weakness. Signs include arrhythmias, e.g. atrial fibrillation, myxedema, proptosis. more

Anorexia, thirst, frequent urination, lethargy, fatigue, muscle weakness, joint pain, constipation. Mild: personality changes, lack of spontaneity, lack of initiative. Moderate: dysphoria, anhedonia, apathy, anxiety, irritability, poor concentration. Severe: confusion, disorientation, agitation, psychosis, lethargy, coma. more

Paresthesias, muscle cramps, carpopedal spasm, rarely facial grimacing, severe ? tetany and seizures. more

Postpartum pituitary infarction. Inability to lacate may be one of the first symptoms. case report

Common with certain anticonvulsants (e.g. valproic acid), elderly, alcoholics, eating disorders, malnourished. Symptoms include cognitive dysfunction. Signs ? megaloblastic anemia. more

Megaloblastic anemia, myelopathy (subacute combined degeneration), dementia, delirium, peripheral neuropathy. Occurs in pernicious anemia, chronic peptic ulcer disease, after gastrectomy or gastric bypass, alcohol dependence, irritable bowel disorder, eating disorders, malnourished. more

Global confusion, ataxia, opthalmoplegia, tremor, nephropathy. Hyperemesis Gravidarum is a risk factor in pregnant female. more

Abdominal pain, peripheral neuropathy, and mental disturbances. Seizures, autonomic instability, dehydration, electrolyte disturbances, dermatologic changes also may occur. Physical symptoms occur in attacks, but psychological ones may persist. case report