Management of puerperal psychosis

Due to the high risk of suicide or infanticide, management of puerperal psychosis needs to be ongoing, often for many weeks or months. Treatment with medication is essential. Assessment and monitoring of the mother–infant interaction is a key part of care of both mother and infant.

Medications:

  • Mood stabilisers are used to treat manic episodes and psychotic symptoms and help reduce relapse. Antipsychotics and antidepressants may also be of benefit, depending on the range of symptoms.
  • A psychiatrist should be consulted when medications are prescribed, changed or ceased, and the potential risks and benefits to the woman and baby should be considered. Medication should not be ceased suddenly.
  • Given the need for medication and maximising sleep in women with puerperal psychosis, the advantages and disadvantages of breastfeeding for mother and baby need to be discussed with the woman and her partner.
  • Sodium valproate and clozapine should not be used without consultation with a psychiatrist.
  • Lithium should be used cautiously. Advice should be sought from a psychiatrist if breastfeeding, and it is important to ensure close monitoring of the baby by a specialist (e.g. neonatologist/paediatrician).
  • A woman’s physical activity levels and diet need to be considered if she is taking antipsychotics (due to their association with weight gain).

Electroconvulsive therapy (ECT):

ECT may be used or even essential to treat acute mania, psychosis and severe depression. This treatment is only used in major hospital settings, with close monitoring of the woman.

Psychological therapies:

Psychological therapies such as CBT or IPT can assist women to develop effective coping strategies as they recover. Mother-infant therapy can be useful in promoting mother-infant bonding. Counselling/support is also recommended for the partner and key support people.

 

See also

Things to remember about puerperal psychosis