1. Postpartum Psychosis (Puerperal Psychosis) Dr Lizzie Davison (GP) Originally presented at Teach The Teacher course November 2015, London

2. True or False? 1.There is no increased risk of suicide in postpartum psychosis is as the baby is a protective factor 2.Sepsis is a more common cause of death than suicide in the postnatal period 3.Postpartum psychosis is a psychiatric emergency 4.Postpartum psychosis occurs in 1 /10,000 births 5.Post partum psychosis is more common in lower socioeconomic groups 6.Postpartum psychosis only occurs in women known to have a mental health condition 7.Family history of mental health problems aren’t important at antenatal booking

3. 6 women died in London [2012-13] due to perinatal mental health problems Suicide always in the top 3 causes of maternal deaths up to 12 months

4. Postpartum Psychosis Psychiatric Emergency Variable symptoms, rapid change Onset: 1 st few days-weeks post delivery Symptoms: Mania/psychosis/depression

5. Symptoms of Postpartum Psychosis feeling ‘high’, ‘manic’ or ‘on top of the world’ low mood and tearfulness anxiety or irritability rapid changes in mood severe confusion restless and agitated racing thoughts behaviour that is out of character more talkative, active and sociable than usual withdrawn and not talking to people finding it hard to sleep, or not wanting to sleep Loss of inhibitions feeling paranoid, suspicious, fearful feeling as if you’re in a dream world delusions. Ie: fixed odd thoughts or beliefs that are unlikely to be true. Eg: believe you have won the lottery/baby is possessed by the devil/paranoia Hallucinations: visual, auditory, olfactory

6. Early symptoms reported (127 women) Excited, elated, high, ‘over the moon’ giggly 52% (66 women) Active, energetic, overactive 37% (47) Chatty, sociable, talking more, always on the phone 35% (45) Busy mind, racing thoughts, lots of ideas 31% (40) Muddled thinking, mixed up, confused, not with it, disorientated 29% (37) No need for sleep 25% (32) Not able to sleep 23% (29) Irritable, people getting on nerves, arguing, angry, impatient 23% (29) Heron J, McGuiness M, Blackmore Robertson E, Craddock N, Jones I. Early postpartum symptoms in puerperal psychosis. British Journal of Obstetrics and Gynaecology. 2008, Feb, 115 (3): 348-353.Early postpartum symptoms in puerperal psychosis

7. What’s the risk of developing Postpartum Psychosis? Background risk = 1 in 1000 (0.1%) Family history (Mother/sister) with postpartum psychosis =3 in 100 (3%)

8. Risk of Postpartum Psychosis if Personal history of mental illness: Bipolar Disorder /Schizoaffective disorder /Schizophrenia = 1 in 4 to 1in 2 (25% to 50%). Personal history of Postpartum psychosis = 1in 2 (50%) will have a 2 nd episode Pre-conception/pre-birth planning are very important

9. Treatable/managable Antipsychotics / Mood stablisers ?Prophylaxis Increased support Family and professional (MW/Obs/GP/HV/Psychiatry team) Mother and Baby Unit

10. Postpartum Psychosis 1 in 1000 women Severe mental illness: psychiatric emergency Starts days/weeks after delivery Variable rapidly changing symptoms Increased suicide risk

11. So what should we do? Increased awareness Family Planning Preconception/prebirth assessment: Ask about mental health: current/past/FHx Refer if needed Not to stop medication suddenly/without proper advice and support Perinatal Psychiatrist / specialist midwife Care Plan (by 32 weeks) & Crisis plan

12. True or False? 1.There is no increased risk of suicide in postpartum psychosis is as the baby is a protective factor 2.Sepsis is a more common cause of death than suicide in the postnatal period 3.Postpartum psychosis is a psychiatric emergency 4.Postpartum psychosis occurs in 1 /10,000 births 5.Post partum psychosis is more common in lower socioeconomic groups 6.Postpartum psychosis only occurs in women known to have a mental health condition 7.Family history of mental health problems aren’t important at antenatal booking

13. Answers True or False? 1.There is no increased risk of suicide in postpartum psychosis is as the baby is a protective factor FALSE 2.Sepsis is a more common cause of death than suicide in the postnatal period FALSE 3.Postpartum psychosis is a psychiatric emergency TRUE 4.Postpartum psychosis occurs in 1 /10,000 births FALSE 5.Post partum psychosis is more common in lower socioeconomic groups FALSE 6.Postpartum psychosis only occurs in women known to have a mental health condition FALSE 7.Family history of mental health problems aren’t important at antenatal booking FALSE

14. Perinatal Psychiatry services 3 London Mother & baby unitsin London: East london:City and Hackney Centre for Mental Health South London:Bethlem Royal Hospital Central & North West London: Coombe Wood Free admission if mental health If for parenting assessment needs funding from social care

15. Further information NICE Guidance Dec 2014:Antenatal and postnatal mental health: clinical management and service guidance http://www.nice.org.uk/guidance/cg192 RCPSYCH website http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/post partumpsychosis.aspx APP website Action Postpartum Psychosis, the UK Postpartum Psychosis Network http://www.app-network.org/ Maternal Mental Health Alliance http://maternalmentalhealthalliance.org.uk/