Prepartum Psychosis and Neonaticide: Rare Case Study and Forensic‐Psychiatric Synthesis of Literature

Abstract

Peripartum psychosis is a rare but serious psychiatric disorder characterized by the presence of a mood episode with psychotic features. Although controversy surrounds the nosological status of peripartum mental disorders, these conditions continue to be of exceptional interest to the medical and forensic mental health communities. The aim of this study was to report a rare case of prepartum psychosis which escalated to the endpoint of neonaticide and summarize literature on peripartum mental disorders and infanticide. A 30-year-old mother murdered her newborn with the spike of her serum delivery system and planned to commit suicide while in hospital after hallucinating due to an acute puerperal psychotic disorder with a prepartum onset and postpartum deterioration. Her disorder was not managed until neonaticide. Throughout this paper, the significance of a multidisciplinary approach for the optimal management of these incidents is highlighted and diagnostic as well as therapeutic issues are addressed.

Organic vs Stimulant-Induced Psychosis in the Peripartum Period

“…In addition to the physical challenges that pregnancy places on a woman’s body, it also increases a woman’s susceptibility to a variety of psychiatric conditions. These may include postpartum blues, peri- and postpartum depression, and brief psychotic disorder with peripartum onset [ 5 ]. The last of these encompasses both pre- and postpartum psychosis and has a recorded incidence rate of less than 0.5% with occurrence increased to 28% of women with a history of psychosis [ 6 - 8 ]; however, it is increasingly rare in women with no previous psychiatric history, such as this patient [ 5 ].…”

“…These may include postpartum blues, peri- and postpartum depression, and brief psychotic disorder with peripartum onset [ 5 ]. The last of these encompasses both pre- and postpartum psychosis and has a recorded incidence rate of less than 0.5% with occurrence increased to 28% of women with a history of psychosis [ 6 - 8 ]; however, it is increasingly rare in women with no previous psychiatric history, such as this patient [ 5 ]. In fact, many consider brief psychotic disorder with peripartum onset to be a manifestation of an underlying psychiatric disorder, most commonly bipolar or schizoaffective disorder, and less commonly schizophrenia [ 9 , 10 ].…”

“…Additionally, prepartum psychosis is much less common, and much less studied, than postpartum psychosis [ 5 ]. In 1990, Brockington et al reported four cases of prepartum psychosis and suggested that they were “evidence for the prepartum onset of postpartum psychosis,” suggesting perhaps that prepartum psychosis was rare, if not nonexistent, on its own accord [ 7 ].…”

Infanticide and its relationship with postpartum psychosis: a critical interpretive synthesis

“…The synthetic construct of prior psychiatric history and treatment was in line with the known literature and the known risk factors for the development of postpartum psychosis . The findings further indicated that women who commit infanticide within the context of postpartum psychosis often receive psychiatric care; however, the care was deemed to be inadequate (Barnett, 2006;Karakasi et al, 2017;Koenen & Thompson, 2008). Inadequate care within the literature was perceived as hospitalisations which were too brief as well as inadequate psychoeducation (Spinelli, 2004).…”

“…The findings of the synthesis further suggest that infants were often killed by the perpetrators using their hands. The most common methods of inflicting death were drowning, head trauma, suffocation, and strangulation (Barnett, 2005;Barnett, 2006;Karakasi et al, 2017;Smithey, 2001;State of Illinois v. Skeoch, 1951). Drowning was mentioned as the most common, mentioned in eight out of the 15 included studies; head trauma was discussed in five; and suffocation or strangulation in seven studies.…”