Let's talk about postpartum psychosis: a severe mental condition that occurs after having a baby!

Isn't it a great joy to welcome a new baby into the family? But sometimes, along with this joy, a new mother has to face unimaginable psychological difficulties. One such rare but very dangerous mental condition that can occur after having a baby is called postpartum psychosis, or ``Postpartum Psychosis - PPP''. This is truly a medical emergency. Therefore, it is very important for us all to be aware of this.

What is Postpartum Psychosis?

Simply put, ``Postpartum Psychosis`` is a serious mental illness that a mother can develop after giving birth. It is not very common, meaning it does not happen to everyone. However, if this condition occurs, it is very dangerous . Because, a person in this condition is very likely to harm themselves, lose their life, or harm their newborn baby.

Most importantly: This is a mental health emergency. If you suspect that you or someone you know is experiencing these symptoms, it is essential to seek immediate medical attention . If you believe that someone is a danger to themselves or others, call 1990 Suwaseriya Ambulance Service immediately, or go to the nearest hospital emergency department.

The best thing is, this is a treatable condition . But it needs to be recognized early and treated properly.

Who does this condition affect? ​​How common is it?

Anyone who has had a baby can experience this condition, known as ``Postpartum Psychosis.'' Most of the time, it appears within a few days of giving birth. However, it can sometimes occur as late as six weeks after birth.

Although anyone can develop it, people with certain mental health conditions are more likely to develop it. Experts still don't know for sure whether these conditions cause PPP, or if there's just a connection between the two. But it's clear that there is a connection.

This is a very rare condition. According to statistics, it affects between 0.089 and 2.6 out of 1,000 births. This means that it is very rare to see it even in Sri Lanka. However, even in that small number, the damage it can cause is great.

What are the symptoms of this?

There are two main symptoms of ``Postpartum Psychosis''. Both of these involve a change in a person's sense of reality, that is, the way they understand the world around them.

Seeing or hearing things that are not real (Hallucinations)

What happens is that your brain feels like things are happening without actually hearing or seeing anything. It's like you hear someone talking, or you see images that aren't there. Sometimes, you can even feel things that you can feel (touch hallucinations). These things can be so real that you can't tell if they're real or not.

Delusions

This means that you have a false belief that you hold on to, and that you can't change it in any way. No matter how much evidence you are shown, you won't change that belief. For example:

• Persecutory delusions are the belief that someone is coming to harm you or your baby.
• Control delusions are the belief that someone else is controlling your body.
• Saying things like you didn't have a baby, you weren't pregnant, are ``somatic delusions''.

Other common symptoms

In addition to these main symptoms, other symptoms may include:

• Mood swings: Suddenly feeling very happy and active (Mania) or (Hypomania), or suddenly feeling very sad and depressed (Depression).
• Depersonalization: Some describe this as a feeling of being outside of your body and looking at yourself.
• Disorganized thoughts or behavior: Things spoken and done change in a chaotic, unrelated manner.
• Insomnia: Not being able to sleep at all.
• Irritability or irritability: Always feeling angry and restless.
• Thoughts of harming oneself or others (especially a newborn baby): This is the most dangerous symptom.

Classification by symptoms

Researchers divide PPP into three main types based on symptoms:

• Depressive
• Manic
• Atypical/mixed

Depressive symptoms

This type is the most common, at about 41%. This is also the most dangerous type. Research shows that in cases of self-harm or child-harm, these depressive symptoms and psychotic symptoms (especially ``Hallucinations'' or ``Delusions'' that command the child or the self to harm themselves) are often seen. In this type, the percentage of child harm is about 4.5%, which is four to five times higher than other types. The percentage of suicide is about 5%.

Characteristics that can be seen in this type:

• Anxiety or panic.
• ``Delusions'' and ``Hallucinations''.
• Depression.
• Guilty feelings.
• Loss of appetite.
• Anhedonia is the lack of pleasure from things that normally bring pleasure.
• Thoughts of harming yourself, committing suicide, or harming your child.

Manic symptoms

This is the second most common type, at about 34%. There is still a risk of harm to oneself or the child, but it is slightly lower (about 1%).

Characteristics:

• Restlessness or irritability.
• Disruptive or aggressive behavior.
• Talking faster or louder than normal.
• Sleeping less.
• Thinking that one's self or one's child is very great and special (e.g., thinking that the child is a god or a saint).

Atypical/mixed features

This type accounts for about 25% of cases. It can be a mix of manic and depressive symptoms. Or, a person may appear to be unaware of their surroundings and unaware of their surroundings.

Characteristics:

• Confused speech or behavior.
• Confusion or disorientation.
• Disturbances of consciousness (appearing to be not fully awake, unaware of what is happening around you).
• ``Hallucinations'' or ``(Delusions)''.
• Inappropriate speech, behavior, or expression of emotions.
• Being completely silent (Catatonia or mutism).

Why does this happen? What are the reasons?

Experts still don't know the exact cause of postpartum psychosis, but they think a combination of factors may play a role.

• Pre-existing mental health conditions: About one-third of people with PPP have a pre-existing mental health condition. The most common of these is Bipolar Disorder (especially Bipolar I Disorder). Conditions such as Major Depressive Disorder and Schizophrenia spectrum conditions can also increase the risk.
• Number of pregnancies: Those who are having their first baby are more likely to develop ``(PPP)''. However, a person who has had ``(PPP)'' before has a 30% to 50% chance of developing it again after the next birth.
• Family history of mental illness, especially PPP: People with PPP may have family members who have had similar conditions. Therefore, it is thought that there may be a genetic link to this.
• Sleep deprivation: It is known that lack of sleep can increase the mania in people with bipolar disorder. It is also thought that sleep deprivation can be a factor in the development of PPP. It can be difficult to get enough sleep with a new baby.
• Hormonal changes: During pregnancy and childbirth, there are major changes in the body's hormone levels. Some hormones suddenly increase, while others suddenly decrease. It is thought that the hormones `(Estrogen)` and `(Prolactin)` in particular are involved. However, more research is needed on this.
• Other medical conditions: Some other medical conditions that can occur during childbirth can also cause psychosis. For example, autoimmune diseases, electrolyte imbalances in the body, vitamin (B1, B12) deficiencies, thyroid disorders, stroke, etc. Also, high blood pressure conditions during pregnancy called ``Eclampsia`` and ``Preeclampsia`` can contribute to this.

How do doctors diagnose this?

A mental health counselorA doctor can diagnose postpartum psychosis based on your symptoms (whether they see it or what you describe) and a physical and neurological exam. Other tests may be done, but they are only done to rule out other medical conditions or other factors that could be causing the psychosis. These tests cannot directly diagnose postpartum psychosis.

Some common tests:

• Blood, urine, or other body fluid tests: These look for things like problems with the body's chemical processes, infections, salt imbalances, and vitamin deficiencies.
• Imaging scans: These look for changes in the structure of the brain. The most common are CT scans and MRI scans.

Your doctor may also use special questionnaires or symptom lists.

What are the treatments? Can this be cured?

Postpartum Psychosis is a completely treatable condition. There are several treatments for it. However, because it is a relatively rare condition, there is limited research on the best treatments for it.

Because this is a mental emergency, it is imperative that someone with this condition be hospitalized and treated as an inpatient. This way, trained medical staff can care for them at all times, provide them with protection, and keep them as comfortable as possible.

Involuntary hospitalization

Because this `(PPP)` condition causes a person to lose their ability to understand reality, they often don't even know they have a mental health problem. Not only that, but they may also be afraid to ask for help because of the `(Delusions)` and `(Hallucinations)`.

Therefore, inpatient treatment for `(PPP)` is often involuntary . That is, it is not the patient who decides to receive treatment. Instead, it is the family and friends who decide to admit the person to the hospital. This can only be done if they are absolutely certain that the person is a danger to themselves or others (especially the baby). This is done for their own safety.

Treatment methods

There are two main treatment methods:

• Medications
• Electroconvulsive Therapy (ECT)

Medications

Various types of drugs help with PPP. Examples:

• Antipsychotic medications
• Mood stabilizers
• Antiseizure drugs
• Lithium

Electroconvulsive Therapy (ECT)

Some people may be scared by the name, because it has been portrayed incorrectly in movies. However, `(ECT)` is a very safe and very effective treatment., especially for conditions with psychosis. This involves sending a very gentle electric current to your brain while you are fully anesthetized (meaning you are asleep), causing a small shock. The shock causes changes in brain function, reducing or eliminating the symptoms of ``(PPP)``.

You will not feel any pain because you are under anesthesia. The shock usually lasts less than two minutes. You will wake up within 15 minutes after an ``(ECT)'' and will be able to walk normally after about half an hour.

About side effects/complications of treatment

This depends on many things, especially the treatment you are receiving and your symptoms. Therefore, your doctor can best explain the risks, complications, or side effects you may experience.

How can I manage symptoms if I can't take care of myself?

In this `(PPP)` situation, because it is impossible to understand what is true and what is false, a person often does not even know that they have a problem. This means that this is not a disease that can be treated or managed alone. Often, these symptoms are first noticed by those close to the patient, and they are the ones who should seek help.

Things to do before pregnancy or childbirth

If you have had PPP before, or if you have conditions like Bipolar Disorder or Schizophrenia (or if someone in your family has these), it is very important to talk to your doctor before you get pregnant and make a plan for what to do if you develop PPP. Also, talk to your partner, family, and close friends about this. Then, if you are unable to make decisions, they can protect you and your baby.

How quickly will I recover after treatment?

This is different for each person. The recovery time will vary depending on the treatment, medications, etc. Your doctor is the only person who can tell you exactly about this.

Can this be reduced or completely prevented?

Because PPP occurs suddenly and without any apparent cause, there is no way to completely prevent it. However, there are some ways to reduce the risk of developing it, especially for people who:

• For those who have developed ``(PPP)`` during a previous childbirth.
• For those with a history of conditions like `(PPP)`, `(Bipolar Disorder)`, `(Schizophrenia)`.
• For those who have any of these conditions in their family.

For people like this, some treatments can reduce the risk of developing PPP. The most commonly used medication is lithium. There are other medications available. Your doctor will recommend the right one for you.

What happens if I have `(Postpartum Psychosis)`?

PPP is a condition that disrupts your sense of reality. It can cause you to feel very scared and anxious due to hallucinations and delusions. The sad thing is, because of the nature of this disease, you may not realize that you have these symptoms.

This can be a source of great anxiety and fear for those around a person with `(PPP)`. However, those loved ones can play a very important role in ensuring the safety of the person with `(PPP)` and their baby.

How long does ``Postpartum Psychosis'' last?

This is a temporary condition . With treatment, it can quickly improve within a few weeks. If left untreated, it can last for weeks or even months. The longer it is left untreated , the more severe and dangerous it becomes . Therefore, seeking help as soon as family members notice these symptoms can be a life-saving action.

What is the outlook for this situation?

``(PPP)`` is a medical emergency because it disrupts a person's reality. This disruption can be so severe that a person may be tempted to commit suicide or harm their own child.

However, it can be cured with treatment. Many people recover and have children without `(PPP)` again in the future. However, many people who develop `(PPP)` are at risk of developing `(Bipolar Disorder)` later in life. Fortunately, the condition is well understood, and there are many treatments for it.

What should I do if someone close to me shows symptoms of ``Postpartum Psychosis''?

People with PPP may not be able to recognize their symptoms or understand that they have a mental illness. This means they don't think they need medical help. Sometimes, when they try to help, they may even think that it's trying to hurt them.

If you notice that someone close to you is showing signs of ``(PPP)'', there are several things you can do to help them:

• Don't criticize or argue. People with `(PPP)` have a hard time understanding what is true and what is false. Avoid criticizing them or arguing with them about truth and falsehood.
• Stay calm. Feelings of doubt and anxiety are common with PPP. You can prevent the situation from getting worse by speaking calmly, respectfully, and in a low voice. If someone with PPP is upset or angry, don't react in the same way. Calmly reassure them that they are safe and not threatened. Never let them feel trapped or in danger.
• Do not leave them alone, even with a baby. People with `(PPP)` are at high risk of suicide or harming their children. Therefore, never leave someone you think may have `(PPP)` alone.
• Seek emergency medical attention. People with PPP are often a danger to themselves and others. The only way to protect themselves and their newborn is to seek emergency medical attention immediately.
• Find support services.There are organizations that provide support and resources for those affected by PPP. As well as international organizations like Postpartum Support International (PSI), there are also public and private sector places that provide mental health services in Sri Lanka. You can also call the mental health helpline number 1926 for guidance.

What is the difference between `(Postpartum Psychosis)`, `(Postpartum Blues)` and `(Postpartum Depression)`?

Mood swings after having a baby are very common, but they can vary from person to person. In addition to ``Postpartum Psychosis``, there are other conditions:

• Postpartum anxiety: It's normal to feel anxious and worried after having a baby. But if those feelings become so overwhelming that you can't control them and can't function properly, that's called postpartum anxiety. This can also occur with postpartum depression.
• Postpartum blues: This is also called the "baby blues." This is very common, affecting up to 85% of women who have had a baby. It is characterized by sudden, uncontrollable feelings of sadness, anger, and frustration. You may also cry frequently and have trouble sleeping. Fortunately, this is short-lived and does not require treatment.
• Postpartum depression: This has the same symptoms as the "baby blues", but they are more severe and last longer. These feelings can last for most of the day, for days, or even weeks. This can affect the way they care for their baby and think about their baby. This is also quite common, affecting about 1 in 7 people who have a baby.
• Postpartum psychosis: This is the most severe of the four. It goes beyond mood swings and involves losing your sense of reality.

Summary and Take-Home Message

Postpartum Psychosis (PPP) is a very serious and dangerous mental condition that affects people who have had a baby. It causes a person to lose their ability to understand reality. Therefore, people with PPP are at increased risk of self-harm, suicide, or harming their children.

However, the most important thing to remember is that PPP is a treatable condition. Many people with this condition make a full recovery and go on to have children again in the future without PPP.

Because people with PPP may not recognize that they have the condition, family and close friends are more likely to notice these symptoms first.If you think someone close to you has PPP, don't hesitate to seek medical help. It can be scary and distressing to see someone close to you suffer from this condition. But you can protect them and their newborn, help them recover, and help them get back to their normal lives with their new family member. Early treatment is key.

` Postpartum Psychosis, PPP, Mental Health, New Moms, After Having a Baby, Mental Symptoms, Treatment