PSYCHIATRIC DISORDERS DURING PUERPERIUM

In the first 3 months after delivery, the incidence of mental illness is high. Overall incidence is about 15–20%. Sleep deprivation, hormone elevation near the end of gestation and massive postpartum withdrawal contribute to the risk.

HIGH RISK FACTORS FOR POSTPARTUM MENTAL ILLNESS:

• Past history: Psychiatric illness, puerperal psychiatric illness.
• Family history: Major psychiatric illness, marital conflict, poor social situation.
• Present pregnancy: Young age, cesarean delivery, difficult labor, neonatal complications.
• Others: Unmet expectations.

PUERPERAL BLUES

• It is a transient state of mental illness observed 4–5 days after delivery and it lasts for a few days.
• Nearly 50% of the postpartum women suffer from the problem.
• Manifestations are—depression, anxiety, tearfulness, insomnia, helplessness and negative feelings toward the infant.
• No specific metabolic or endocrine abnormalities have been detected. But lowered tryptophan level is observed. It suggests altered neurotransmitter function.
• Treatment is reassurance and psychological support by the family members.

POSTPARTUM DEPRESSION

• It is observed in 10–20% of mothers.
• It is more gradual in onset over the first 4–6 months following delivery or abortion.
• Changes in the hypothalamo–pituitary–adrenal axis may be a cause.
• Manifested by loss of energy and appetite, insomnia, social withdrawal, irritability and even suicidal attitude.
• Risk of recurrence is high (50–100%) in subsequent pregnancies.

TREATMENT: TREATMENT IS STARTED EARLY.

General supportive measures are essential as in blues. If no prompt response with medication, psychiatric consultation is sought for. The overall prognosis is good.

POSTPARTUM PSYCHOSIS (SCHIZOPHRENIA): -

• Observed in about 0.14–0.26% of mothers. Commonly seen in women with past history of psychosis or with a positive family history.
• Onset is relatively sudden usually within 4 days of delivery.
• Manifested by fear, restlessness, confusion followed by hallucinations, delusions and disorientation (usually manic or depressive). Psychotic women may have delusions. Suicidal, infanticidal impulses may be present. In that case temporary separation and nursing supervision are needed.
• Risk of recurrence in the subsequent pregnancy is 20–25% and there is increased risk of psychotic illness outside pregnancy also.

HOMOEOPATHIC MEDICINES FOR MANAGING PSYCHIATRIC DISORDERS DURING PUERPERIUM: -

1) Aconite: for intense, sudden anxiety, panic or fear.

2) Argentum nit: - This is sometimes indicated for people with anxiety due to uncertainty. Uncertainty based anxiety could be accompanied with digestive disturbance like diarrhea, and sweet cravings.

3) Arsenicum album: - this is indicated for people having anxiety due to fear of loneliness, darkness, or being imperfect.

4) Calcarea carb: - indicated in those who develop fear of breaking out of any safe routine. Anxiety worsens when plans are changed, and they show difficulty in going with the flow.

5) Gelsemium: - for people facing anxiety due to feelings of inadequacy. People with this type of anxiety are often timid and shaky. They often desire solitude and avoid insistent pressure from other people.