Post-partum psychosis: a case report

Felicia Deonarine

doi:10.33178/SMJ.2024.1.10

Authors

Felicia Deonarine https://orcid.org/0009-0001-8825-2311

DOI:

https://doi.org/10.33178/SMJ.2024.1.10

Keywords:

psychiatric admission, Post-Partum, Case Report

Abstract

The patient (NS) is a 5 month post-partum 32 year old woman, G2P2, who presented to the Cork University Hospital (CUH) Emergency Department by ambulance. She presented to the ED distressed, anxious and confused. Her family history is significant for depression. Her personal history is significant for long periods of separation from her spouse and an increased workload and chores list at home, leading to high levels of stress and anxiety. Her past medical history includes two births, both caesarean and non-complicated. However, she contracted a SARS-CoV-2 infection prior to her most recent delivery. Her eldest child is 6 years old and her most recent is 5 months. Prior to NS’s deterioration, she was described as level-headed, dependable, quiet, and overall an extremely competent mother. Her physical examination was non-contributory. Finally, on December 5^th 2022, her condition improved. Her MSE showed a tidy appearance, non-paranoid body language, sequential speech, reactive mood, logical and non-paranoid thoughts, good insight about psychosis, excellent cognition, and low risk for harm to herself or others. In this case report, the biopsychosocial aspects of the patient’s recovery are discussed.

References

Florio AD, Smith S, Jones I. Postpartum psychosis. Obstetrician Gynaecol. 2013;15(3):145–50.

Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T Peer-reviewed J Formulary Management. 2014;39(9):638–45.

Bobo WV. The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update. Mayo Clin Proc. 2017;92(10):1532–51.

Machado-Vieira R, Luckenbaugh DA, Ballard ED, Henter ID, Tohen M, Suppes T, et al. Increased Activity or Energy as a Primary Criterion for the Diagnosis of Bipolar Mania in DSM-5: Findings From the STEP-BD Study. Am J Psychiat. 2017;174(1):70–6.

Paudel S, Vyas CM, Peay C, Sorg E, Abuali I, Stern TA. New-Onset Paranoia in an Elderly Woman With Bipolar Disorder: Differential Diagnosis, Evaluation, and Treatment. Prim Care Companion Cns Disord. 2022;24(4).

Arciniegas DB. Psychosis. Continuum Lifelong Learn Neurology. 2015;21(3, Behavioral Neurology and Neuropsychiatry):715–36.

VanderKruik R, Barreix M, Chou D, Allen T, Say L, Cohen LS, et al. The global prevalence of postpartum psychosis: a systematic review. Bmc Psychiatry. 2017;17(1):272.

Osborne LM. Recognizing and Managing Postpartum Psychosis A Clinical Guide for Obstetric Providers. Obstet Gyn Clin N Am. 2018;45(3):455–68.

Florio AD, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, et al. Perinatal Episodes Across the Mood Disorder Spectrum. Jama Psychiat. 2013;70(2):168–75.

Blackmore ER, Rubinow DR, O’Connor TG, Liu X, Tang W, Craddock N, et al. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord. 2013;15(4):394–404.

Morris E, Hippman C, Albert A, Slomp C, Inglis A, Carrion P, et al. A prospective study to explore the relationship between MTHFR C677T genotype, physiological folate levels, and postpartum psychopathology in at-risk women. Plos One. 2020;15(12):e0243936.

Lewis KJS, Florio AD, Forty L, Gordon-Smith K, Perry A, Craddock N, et al. Mania triggered by sleep loss and risk of postpartum psychosis in women with bipolar disorder. J Affect Disorders. 2018;225:624–9.

Bergink V, Laursen TM, Johannsen BMW, Kushner SA, Meltzer-Brody S, Munk-Olsen T. Pre-eclampsia and first-onset postpartum psychiatric episodes: a Danish population-based cohort study. Psychol Med. 2015;45(16):3481–9.

Jairaj C, Fitzsimons CM, McAuliffe FM, O’Leary N, Joyce N, McCarthy A, et al. A population survey of prevalence rates of antenatal depression in the Irish obstetric services using the Edinburgh Postnatal Depression Scale (EPDS). Arch Womens Ment Health. 2019;22(3):349–55.

Shrestha SD, Pradhan R, Tran TD, Gualano RC, Fisher JRW. Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: a systematic review. Bmc Pregnancy Childb. 2016;16(1):72.