CAMARINES SUR POLYTECHNIC COLLEGES

COLLEGE OF HEALTH SCIENCES

group 3:

POSTPARTUM
PSYCHOSIS
AFTER TRAUMATIC
CESAREAN DELIVERY
Overview
II. Introduction VIII. Manifestation with Rationale
III. Learning Objectives IX. Diagnostic Evaluation
IV. Background Theoretical
V. Patient Data and History Actual
Medical History X. Intervention and Treatment
Nursing Health History Medical
VI. Anatomy and Physiology Pharmacological
VII. Pathophysiology Surgical
Narrative XI. Prognosis
Diagram XII. Drug Study
Comparative analysis XIII. Nursing Care Plan
INTRODUCTION
Presenters:

l e j a

A
Ren z
THE
Presenters:
thy
LEARNING
OBJECTIVES
u

R
&
DRUG STUDY

BACKGROUND
&
PATIENT

a
HISTORY AND

Han n DATA
THE
Presenters:
ora
ANATOMY r

Au
AND
PHYSIOLOGY

PATHOPHY-

n
SIOLOGY

K C- l y
THE
Presenters:
zel
MANIFESTATION
WITH
a

H
RATIONALE

DIAGNOSTIC
EVALUATION
&
INTERVENTION

is
Lew
AND
TREATMENT
THE
Presenters:
borah
e

D
PROGNOSIS

NURSING

ss
P ri ce
CARE PLAN

n
Introduction
Postpartum psychosis (PP) is a rare illness
compared to the rates of postpartum anxiety and
depression. It occurs in 0.89 to 2.6 out of every
1000 births.
The onset of most postpartum psychosis
episodes is within 2 weeks of delivery.
Infrequently, in cases of severe Psychosis or
psychotic depression, infanticide may also be
committed.
In this research, women with BD run a twofold
increased risk for cesarean delivery compared
to women without BD, of similar age and parity.
 Review the potential risk factors for developing
1 postpartum psychosis.

Learning 2
For health care professionals to identify suspicious
symptoms and promptly refer to psychiatric services so
as to ensure the mother’s and the newborn’s safety.

Objectives 3
To know the importance of assessing women with bipolar
disorder or a previous psychotic episode for the risk of
psychiatric complications in pregnancy and after
childbirth.

4 Describe the typical presentation of a patient with

postpartum psychosis.

Explain the importance of improving communication and

5 collaboration between interprofessional teams to

enhance the delivery of care in postpartum psychosis.

Midwifery education on perinatal mental health is crucial.

6 For the detection of suspicious symptoms and early
referral to a specialist
Background
This case study is part of a larger survey on postpartum PTSD. Due to the rarity of
the incident, we proceeded after the written consent of the patient for further
investigation. The purpose of this study was to raise the awareness of
obstetricians and midwives in the follow-up of suspicious signs during
antenatal care that could develop into psychiatric emergencies during or after
delivery. In this case report, we describe the episode of postpartum psychosis of a
primiparus woman in her early 30s, with undiagnosed bipolar disorder who was
admitted for an emergency cesarean section due to preeclampsia.
PATIENT’S DATA
The patient reported a brief psychotic episode as an
adolescent after her mother’s death
At that time, she exhibited agitated and aggressive

& HISTORY
behavior with a persecutory delusion that her father’s
mistress had killed her mother by intravenously
administering poison.

medical
While hospitalization was recommended, the family refused,
and she only received treatment with olanzapine for 6
months
Regarding her family history, in the first and second

HISTORY interview, she mentioned that her mother might have

suffered from depression
During the third interview (week 10 postpartum), the patient
felt safe enough to reveal that her mother had a history of
bipolar disorder and apologized for not saying that in the
first place because she did not want to be stigmatized.
 The patient presented to
the maternity hospital due
to the onset of full-term
labor contractions.
Very anxious and labile in
her mood, talking loudly in
nursing the waiting room
Diagnosed with

health preeclampsia (200/100

mm Hg)
A cesarean section within

HISTORY an hour after her

admittance to the hospital
She quickly became
paranoid with the
persecutory thought that
the doctors “wanted to
steal her baby”
Nursing Health
History (contd.)
She reported intense terror at
the sight of the operating room
She had a vague memory of her
behavior and that she spoke
abruptly to doctors and
She expressed the midwives.
delusional belief She was rather confused and
feeling guilty and reported that
The patient underwent an
was something out of her
emergency cesarean character
section under general On postpartum day 2, the
anesthesia patient was depressed and
The newborn, a 3500gr described moments of anxiety,
loss of control, and a feeling of
girl, was removed from her imminent death for her and her
mother baby
During the last two pregnancy
trimesters, she had gained 40
kilos (from 55–95 kg), which
resulted in preeclampsia
The psychiatric episode was
described by the psychiatrist as
an acute manic episode
During hospitalization, diazepam
was administered
intramuscularly to control the
symptoms
After the cesarean section, there
was no urine albumen, and the
values of blood pressure were
normal. The results of further
tests of electrolytes, calcium,
uric acid, phosphorus, and TSH
levels were within normal limits.

anatomy &
physiology(contd.)
Amygdala - is the integrative center for emotions, emotional
behavior, and motivation. If the brain is turned upside down the end
of the structure continuous with the hippocampus is called the
uncus. If you peel away uncus you will expose the amygdala which
abuts the anterior of the hippocampus.
 
Hippocampus - is a complex brain structure embedded deep into
temporal lobe. It has a major role in learning and memory. It is a
plastic and vulnerable structure that gets damaged by a variety of
stimuli. Studies have shown that it also gets affected in a variety of
neurological and psychiatric disorders.
Prefrontal cortex - is a part of the brain located at the front of the
frontal lobe. It is implicated in a variety of complex behaviors,
including planning, and greatly contributes to personality
development.
Hypothalamus - a structure deep in your brain, acts
as your body's smart control coordinating center. Its
main function is to keep your body in a stable state
called homeostasis. It does its job by directly
influencing your autonomic nervous system or by
managing hormones.
Pituitary Gland - is a small, pea-sized endocrine
gland located at the base of your brain below your
hypothalamus. It releases several important
hormones and controls the function of many other
endocrine system glands.
Adrenal cortex - is the outer region and also the
largest part of an adrenal gland. It is divided into
three separate zones: zona glomerulosa, zona
fasciculata and zona reticularis. Each zone is
responsible for producing specific hormones.
Glucocorticoids - are cholesterol-derived steroid
hormones synthesized and secreted by the adrenal
gland. They are anti-inflammatory in all tissues, and
control metabolism in muscle, fat, liver and bone.
Glucocorticoids also affect vascular tone, and in the
brain influence mood, behavior and sleep‒
wakefulness cycles.
anatomy & physiology (contd.)
Patho-
NARRATIVE
physio Most strongly linked to the pathophysiology of psychotic disorders is
logy the neurotransmitter dopamine. The positive symptoms of psychotic
disorders are believed to be caused by excess dopamine in the
mesolimbic tract. Glutamate, an excitatory neurotransmitter, is also
implicated. Multiple studies have found a decreased function of the
N-methyl-D-aspartate (NMDA) glutamate receptor. Studies have
also pointed to gamma-amino-butyric acid (GABA), an important
inhibitory neurotransmitter. Some studies show evidence of
dysfunction in patients with subjects with schizophrenia. Lastly,
implications point to an imbalance in acetylcholine. This finding
developed while observing the smoking behaviors of patients with
schizophrenia, as nicotine has been shown to increase acetylcholine
function. Observers noted some improvements in deficits in the
smokers, and cognition was improved in studies as well.
Comparative
analysis

Illustration representing the four regions that showed smaller areas in PPE compared
to NPPE. (a) Postcentral gyrus in purple and ACC in yellow. (b) Parahippocampal gyrus
in blue and superior temporal gyrus (STG) in pink
Manifestations with
rationale
THEORETICAL
Psychosis is when a person loses touch with reality. They
may start to see, hear, and/or believe things that aren’t
true. This effect can be very dangerous for a new mother
and her baby. Of the women who develop a postpartum
psychosis, research has suggested that there is
approximately a 5% suicide rate and a 4% infanticide rate
associated with the illness. This is because the woman
experiencing psychosis is experiencing a break from
reality. In her psychotic state, the delusions and beliefs
make sense to her; they feel very real to her and are
often religious. Immediate treatment for a woman going
through psychosis is imperative.
ACTUAL
Postpartum psychosis symptoms are similar to those of a bipolar,
manic episode. The episode usually starts with the inability to
sleep and feeling restless or especially irritable. These symptoms
give way to more severe ones. Examples include:
auditory hallucinations (hearing things that aren’t real, such as suggestions for a
mother to harm herself or that the baby is trying to kill her)
delusional beliefs that are usually related to the infant, such as that others are
trying to harm her baby
disoriented as to place and time
erratic and unusual behavior
rapidly changing moods from extreme sadness to very energetic
suicidal thoughts
violent thoughts, such as telling a mother to hurt her baby
Postpartum psychosis can be severe for a mother and her little one(s). If these
symptoms occur, it’s vital that a woman receive medical help immediately.
Diagnostic evaluation
THEORETICAL
The clinical picture of postpartum
psychosis includes Early manifestations
symptoms such as insomnia, mood
changes, obsessive thoughts about baby,
and later delusions, hallucinations,
disorganized behavior, psychomotor
agitation, food rejection, catatonia, and
severe mood changes.
ACTUAL
There’s no blood test or body scan that shows a patient
have this mood disorder. Instead, the health care
provider will ask certain questions about the patient’s
state of mind. The most common PPP screening tests
are:
Edinburgh Postnatal Depression Scale (EPDS)
2-Question Patient Health Questionnaire (PHQ-2)
9-Question Patient Health Questionnaire (PHQ-9)
Brain imaging
Summary and Conclusion
MEDICAL
In medical treatment we can make
use of Psychotherapy. It may help to
talk through the patient’s concerns
with a psychiatrist, psychologist or
other mental health professional.
Through therapy, the patient can
find better ways to cope with their
feelings, solve problems, set realistic
goals and respond to situations in a
positive way. Sometimes family or
relationship therapy also helps.
Examples of therapies used for
postpartum psychosis/ depression
include cognitive-behavioral
therapy (CBT) and interpersonal
psychotherapy.
PHARMACO- SURGICAL
LOGICAL
In surgical treatment,
Electroconvulsive therapy (ECT) can
Treatment may require a be used. If postpartum depression is
combination of medicines severe and experience postpartum
such as antidepressants psychosis, ECT may be
recommended if symptoms do not
Fluoxetine (Prozac,
respond to medicine. ECT is a
Sarafem), antipsychotic procedure in which small electrical
medicines (Olanzapine) , currents are passed through the
brain, intentionally starting a brief
mood stabilizers and
seizure. ECT seems to cause
benzodiazepines to control changes in brain chemistry that can
your signs and symptoms. reduce the symptoms of psychosis
and depression, especially when
other treatments have been
unsuccessful.

Prognosis
Postpartum psychosis is a condition that disrupts your sense of reality. The hallucinations
and delusions it causes can cause intense fear and anxiety. Unfortunately, the symptoms of
this disease mean it’s very rare for you to be aware that you have the symptoms of this
mental health condition.

Postpartum psychosis is a temporary condition. With treatment, people who have it can
recover relatively quickly within a few weeks. Without treatment, postpartum psychosis
can last for weeks or even months. This condition also becomes more severe and more
dangerous the longer it goes untreated, so it’s vital that family members or loved ones
recognize the symptoms and help get treatment for a person with postpartum psychosis.
Drug Study
Nursing Care Plan