Course and Treatment
Without treatment, these psychoses can last many months; but with modern therapy they usually resolve within a few weeks. A small minority follow a relapsing pattern, usually related to the menstrual cycle. Mothers who suffer a puerperal episode are liable to other manic depressive or acute polymorphic episodes, some of which occur after other children are born, some during pregnancy or after an abortion, and some unrelated to childbearing. Puerperal recurrences occur after at least 20% of subsequent deliveries, or over 50% if depressive episodes are included.
Severe overactivity and delusions may require rapid tranquilization by neuroleptic (antipsychotic) drugs, but they should be used with caution because of the danger of severe side effects including neuroleptic malignant syndrome. Electro-convulsive (electroshock) treatment is highly effective. Mood stabilizing drugs such as lithium are also useful in treatment and possibly the prevention of episodes in women at high risk (i.e., women who have already experienced manic or puerperal episodes). The location of treatment is an issue: hospitalization is disruptive to the family, and it is possible to treat moderately severe cases at home, where the sufferer can maintain her role as a mother and build up her relationship with the newborn. This requires the presence, round the clock, of competent adults (such as the baby's maternal grandmother), and frequent visits by professional staff. If hospital admission is necessary, there are advantages in conjoint mother and baby admission. Yet multiple factors must be considered in the subsequent discharge plan to ensure the safety and healthy development of both the baby and its mother. This plan often involves a multidisciplinary team structure to follow-up on mother, baby, their relationship and the entire family.
Suicide is rare, and infanticide extremely rare, during these episodes. It does occur, as illustrated by the famous cases summarized below. Infanticide after childbirth is usually due to profound postpartum depression (melancholic filicide) when it is often accompanied by suicide.
Read more about this topic: Postpartum Psychosis
Famous quotes containing the word treatment:
“I feel that any form of so called psychotherapy is strongly contraindicated for addicts.... The question “Why did you start using narcotics in the first place?” should never be asked. It is quite as irrelevant to treatment as it would be to ask a malarial patient why he went to a malarial area.”
—William Burroughs (b. 1914)