Postpartum Psychosis: Risk factors and Management

Following childbirth, with a psychosis and associated mood disturbance, Postpartum Psychosis (PPP) is studied to be a severe mental health condition. PPP affects 1 to 2 per 1000 women among the psychiatric emergency. To curb this severe disorder, acute clinical intervention is warranted. Maternal mental health problems with a focus on depression as the condition with the biggest public health impact should be the way forward. This review is set to look into the risk factors, prevention and management of PPP. Both the acute onset and recurrence of psychiatric illness are common during the perinatal period as women are more vulnerable during this period. Timely detection and effective management of perinatal psychiatric disorders are critical for managing PPP. Part of the management strategies for women who experience PPP is to seek guidance on further pregnancies and risk of illness. Since PPP is a disturbing complication of childbirth that carries high risks for both mother and child, if one is at high risk of developing puerperal psychosis, there is the need for a specialist care during pregnancy and be seen by a psychiatrist.

postpartum Psychiatric disorders –A neglected Issue

Postpartum period along with pregnancy are considered to be emotionally susceptible periods. The association between emotional or psychiatric disorders and postpartum period has been documented since Hippocratic times. Hormonal changes have been implicated, along with multiple factors in the development of depression associated with postpartum period. Moreover, maternal depression can have devastating effects on neonate as well. This study explores an important area to assess the magnitude of problem in our setup, so that appropriate evaluation of mental health status and up-to-date management can be planned. Objective: To find out psychiatric morbidity among females presenting during postpartum period at a tertiary care hospital in Lahore. Methods: A cross-sectional study was done in Department of Obstetrics and Gynaecology of Central Park Teaching Hospital, Lahore. One Hundred women presenting in peripartum period were included in the study, using purposive sampling technique. After an informed consent participant's bio data was recorded. A structured proforma was used for psychiatric evaluation of the cases, which contained social and demographic details along with questions from Edinburgh postnatal depression scale. Psychiatric diagnosis was made according to DSM-5. Severity of illness was assessed using Hamilton rating scale for depression and Hamilton anxiety rating scale. Results: Postpartum follow up of 100 females revealed that 18% developed psychiatric morbidity. 13 had major depressive disorder and 5 females had anxiety disorder. There was no case of puerperal psychosis in any of the females postpartum in this study. Psychiatric morbidity and age group between 18-25 years (20.6%) showed significant correlation. Similarly, higher incidence of psychiatric morbidity was observed in women living in nuclear household (24.1%). Conclusion: Psychiatric morbidities are common among females during postpartum period. Major depression is the commonest one. Therefore assessment for depression should be included in routine obstetric follow-ups. Key Words: psychiatric morbidity, major depression, anxiety disorder, puerperal psychosis, postpartum females.

FETO-MATERNAL PROTECTIVE FUNCTION OF PROGESTERONE DURING PARTURITION – A NEW PERSPECTIVE.

Normal parturition concludes with safe delivery of viable conceptus by forceful emptying of uterus in humans. With already well accepted experimental and clinical observations, new perspective tries to explain it by calcium ions [Ca2+] lowering action of Progesterone [PR] and Negative feedback regulation of Oestrogen[OE] on Human chorionic gonadotropin[HCG] as follows. Respiratory centre stimulatory effect of PR causes respiratory alkalosis and consequentially converts biologically active plasma free Ca2+ to its’ inactive protein bound store. Thus PR induced low plasma Ca2 maintains pregnancy by supressing myometrial and neural excitability. At term normal fetal organogenesis coordinated with feto-placental steroidogenesis, cause OE negative feedback on HCG, inhibiting both OE and PR synthesis. Due to shorter biological half-life [t/2 = 30min], PR dip is first observed. So the sudden PR withdrawal at term causing acute respiratory acidosis with spark release of plasma Ca2+, facilitates neuro- myometrial excitability triggering parturition. During each myometrial contraction, sandwiched PR gets squeezed from placental store into maternal circulation again resulting in myometrial relaxation. Thus myometrial alternate cyclical repetition of contraction and relaxation [labour pains] continues till completion of parturition. Awareness of importance of gradual intermittent release of placental PR and spark plasma Ca2+ helps clinicians in prevention of feto-maternal mortality and morbidity including puerperal psychosis associated with clinical conditions of sudden PR withdrawal as in caesarean section, precipitous labour, premature labour, preeclamsia etc. which can be treated by building better body blood buffers.

Demographic and Clinical Profile of Patients Receiving Electroconvulsive Therapy at Federal Neuropsychiatric Hospital Yaba in Lagos, Nigeria

Aims: To obtain sociodemographic and clinical profile of patients receiving Electroconvulsive therapy in a Nigerian psychiatric hospital. Study Design: A retrospective study. Place and duration: The study was carried out at the Federal Neuropsychiatric Hospital Yaba, Lagos, Nigeria over a period of 3 months. Methodology: An extensive review of the hospital records of patients receiving the modified form of electroconvulsive therapy for the first time over a period of eight years was done. The demographic information, clinical diagnosis and indication for electroconvulsive therapy were retrieved and analysis was done using SPSS 19. Results: There were a total of 222 cases, ranging from 45 in 2000 to 21 in 2007. Mean age was 31.7 ± 9.65. Male: female ratio was 1:2. Almost 60% of them were single and unemployed. Clinical diagnosis using ICD 10 ranged from schizophrenia (44.8%), severe depression (27.8%), bipolar disorder (15.5%) to puerperal psychosis (8.2%). Indications for electroconvulsive therapy included psychosis (41.6%), severe depressive episode (25.8%), catatonia (23.7%) and manic episode (7.4%). Conclusion: This study has shown that the use of ECT has declined in the facility over the study periods. Also, females were twice as likely to receive electroconvulsive therapy compared to males and schizophrenia still remains the most common diagnosis among the patients.