Characteristics of Post-Partum Mental Illness

Post partum disturbance ... A review of the literature in terms of stress response

“…The nature of the onset of psychosis versus neurotic depression tends to support the importance of cumulative stress factors. Signs of psychotic disturbance occur early in the pregnancy according to Madden, indicating a personality predisposition, although overt depression or other types do not usually occur until the immediate post partum period 12,11 . Dalton 16 observed a continuum through pregnancy of early anxiety, to elation, to depression in the puerperium, but her findings are not supported by others 17 .…”

“…While puerperal depression mimics the tearfulness, restlessness and depressed feelings of the “blues” the disturbance in thought processes identify a distinct psychopathology 10 . Disturbances in the level of severity of puerperal depression, mania, schizophrenia and delirium occur with an incidence of approximately 1‐2 cases per 1000 births 6,11,12 and of these, depression constitutes approximately 2.9% 10 . While post partum reactions are common 6 the more severe reactions, psychoses, are not.…”

“…In 1911, 4% of post partum illness was diagnosed in this later category as compared to 20% in 1958 6 . Madden attributes this increase to a recognition of diagnostic subtleties, but also acknowledgement of the difficulties and dynamics of role adjustment in motherhood as precipitating stress factors 12 .…”

“…Rejection of the infant is classically seen in psychotic responses regardless of diagnosis. Hostile fantasies to the patient's mother and about death or damage to the infant, antagonism to the marital partner and rejection of the union, and ambivalence about sexual identity additionally characterize the psychic constellations of the client and are the same as those of illness unrelated to childbearing 6,13,14,12 . Depression may be psychotic or neurotic, but themes of loss, guilt and dependency predominate and low self esteem with a sense of personal inadequacy, occur consistently 15 .…”

“…Pitt and Yalom found post partum maternity blues relatively benign and self limiting. More severe psychotic reactions have required institutionalization and with the advent of the major tranquilizers, chlor‐promazine 2,12 . Recalcitrant cases of depression have favorably responded to ECT 6 and monamineoxidase inhibitors have also been utilized.…”