Post-Partum Psychosis – Rare but Real

The existence of post-partum psychosis and post-partum depression has been hotly contested publicly. Tom Cruise’s denouncement of Brooke Shields’ diagnosis of post-partum depression is perhaps the most visible example of the controversy among laypeople, but in the medical literature the reality of both post-partum depression and post-partum psychosis is much more well-established.

The so-called “baby blues” are common, affecting 30-75% of new mothers (fathers are affected too). True post-partum depression is less common, affecting 10%, while post-partum psychosis afflicts around 1 to 2 out of 1000 new mothers. Other than the precipitating event, post-partum depression differentiates itself from standard depression by having a somewhat lower age of onset and lower incidence of suicide, while having a higher degree of obsessional behavior and anxiety. For obvious reasons, wild swings in hormones are thought to play a role, although no consistent pattern of hormonal alterations leading to depression has yet been identified.

As opposed to post-partum depression, post-partum psychosis differentiates itself from standard psychosis primarily by its precipitating factor: childbirth. Personal or family history of bipolar disorder is perhaps the strongest risk factor for the development of post-partum psychosis. Women with bipolar disorder who also have a family history of post-partum psychosis are at highest risk, with an estimated 570 of 1,000 individuals with this profile developing the disorder in the post-partum period. Early age at parenthood is also a risk factor for obsessional problems in the post-partum period. Women with one episode of post-partum psychosis are also at risk of recurrent mental illness, with 51% developing an illness in a non-childbirth associated setting, and 38% having a recurrent episode of post-partum psychosis with subsequent deliveries. The rarity of this disorder has precluded thorough testing of treatment methods, although electroconvulsive therapy (ECT) has shown some promise. In patients with pre-existing bipolar disorder or a history of psychotic episodes in the post-partum period, mood stabilizers such as lithium may reduce the rate of relapse.

The question remains as to whether the tragedy of the dismembered infant could have been avoided. Although little is known at this time about the mother’s medical history or medication use, the best answer we can give at this time is: maybe.

References

Seyfried, L., & Marcus, S. (2003). Postpartum mood disorders International Review of Psychiatry, 15 (3), 231-242 DOI: 10.1080/0954026031000136857

FAIRBROTHER, N., & ABRAMOWITZ, J. (2007). New parenthood as a risk factor for the development of obsessional problems Behaviour Research and Therapy, 45 (9), 2155-2163 DOI: 10.1016/j.brat.2006.09.019

Tam, W., & Chung, T. (2007). Psychosomatic disorders in pregnancy Current Opinion in Obstetrics and Gynecology, 19 (2) DOI: 10.1097/GCO.0b013e3280825614