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Puerperal psychosis 

Puerperal psychosis
Chapter:
Puerperal psychosis
Author(s):

Ian Jones

, Jessica Heron

, and Emma Robertson Blackmore

DOI:
10.1093/med/9780199214365.003.0019
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date: 20 September 2018

The link between childbirth and mental illness has been recognized for hundreds, if not thousands, of years. The concept of puerperal or postpartum psychosis (PP) has a long history, but has fallen into disrepute in the age of modern classifications that do not recognize this disorder as a nosological entity. Even in the 21st century, however, the triggering of severe episodes of illness by childbirth remains a significant public health problem, tragically illustrated by a number of cases in which women suffering from puerperal psychosis have killed themselves or harmed their baby (Jones and Craddock 2005). Suicide is a leading cause of maternal death in the UK and it is clear that a high proportion of maternal suicides occur in women with an acute onset of psychosis in the early postpartum period (CEMACH 2007).

Although as a concept, PP is controversial, the occurrence of severe episodes of psychiatric illness with onset in the immediate postpartum is clearly of great clinical importance. The stakes are high and the early recognition and prompt treatment of women who become ill is vital.

In this chapter we will pose, and attempt to answer, a number of questions in relation to PP. We will first consider what constitutes an episode of this disorder and its typical clinical presentation. We will then move on to discuss its epidemiology, nosology, aetiology, and, finally, focus our attention on management, and in particular how to identify and manage women at risk.

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