Postpartum psychosis is the most severe type of postpartum psychiatric illness. It can occur as early as 2 to 3 days after delivery but is more common in the first 2 to 4 weeks postpartum. The incidence of postpartum psychosis is 1 to 2 per 1,000 women. Risk factors identified are history of bipolar illness or depression, family history of mental illness, sleep deprivation, stress, poor support systems, and low self-esteem. Early diagnosis and treatment are crucial for obtaining a positive outcome for both mother and infant.
A42-year-old G7P3 was admitted at 41 weeks for a stat cesarean for fetal distress. A previous history of depression and two other psychotic episodes existed. The patient had a 9lb healthy infant daughter, who she was breast feeding. The husband stayed with his wife and daughter and other children visited. On day 3, the patient walked out of the bathroom with a blank stare, got into bed and started a rocking movement, clutched blankets to her chest and sang church hymns in a loud voice. The patient would not respond to name and would not eat or drink. At one point, the patient cried that the voices were telling her to kill her infant. A psychiatric consult was done immediately, and a stat head computed tomography scan, metabolic profile, thyroid stimulating hormone, rapid plasma regain, and 1:1 sitters were ordered. Antiagitation medications were ordered. Results of above tests were normal. A multidisciplinary team of social work, psychiatry, nursing, obstetricians, and pastoral care worked to address this patient's symptoms and needs. Six days post cesarean, the patient was transferred to a private inpatient psychiatric facility for 2 weeks. The patient then was treated as an outpatient with regular office visits.
Early identification and treatment of postpartum psychosis is imperative for the well-being of the mother and to help establish her ability to care for her infant and resume her normal activities. Early and excellent nursing intervention and care were crucial in ensuing this patient's return to a productive role as a wife and mother.