After the 2nd baby, my wife appear to have mood issues akin to post natal or post partum depression. She does experience mood swing, occasional pain in lower abdomen, headache, stomach, pains similar to labour with pelvic stress etc. She's done quite a lot of medical tests in good clinics with no significant findings. Recently she turned violent nearly smashing my skull with a hammer. She appear to hallucinate -seeing some figures. I have put up with this for nearly 3 years. Orthodox and herbal applications have not worked. Her near illiterate mother has quickly latched on this situation by alluding everything to witchcraft.

I have not checked her for depression. Any suggestion or direction that might help before my marriage collapses? Perhaps an experienced mental health expert around will be appreciated.

Sorry to read about your experience. I am a Mental Health Practitioner and may be of help.

This is a very delicate issue, but to be able to help you, i would like to know a bit more about her presentation. Of course you should ensure that the info. you give remains 'confidential' as this is a very public forum.

1. When you say 'mood swings' can you be a little bit more specific. Does the mood 'swing' from being very low (when she would not have the energy to do anything, be feeling sorry for herself, not enjoy the company of family members etc) to a 'high' when she'd come across as full of energy, irrational in her thinking, irritable etc? When she turned 'violent' can you remember the precipitant? What was her explaination for the behaviour?

2. The 'hallucinations' you mentioned are they real to her? i.e. is she convinced that they are real? Does she also hear 'voices' etc.

3. What does she think of the children or how does she relate with them?

4. Can you say more about what she was like before she started to have children. For instance did she have periods of being withdrawn, irrational, too preoccupied with others plotting against her or  about people trying to harm her?

5. Is there any family history of 'unusual' behaviour on her side?

postpartum depression is a serious thing, i'd suggest you take her to counselling or see a psychiatrist for proper help.

@Beneli

Thank you for the interest. Let me provide a bit more insight into the challenge. On mood swing -e.g You could just agree happily on something  in the morning only to come back later to meet her seriously upset. No connection to the earlier agreement. You could call her on the phone in the day time and hear her crack jokes only to get home to a very harsh tone. She enjoys the company of other family members. A few times though, the relationships gets rough. She strongly believes I am responsible for her problems. Violence gets triggered when I say something she finds upsetting.

Hallucinations -she's very convinced they are real. Hear voices.
Her behaviour before bearing -Would know really. she took in very early and inconveniences of pregnancy set in
Family history -Not quite. The mum behaviour is quite bizarre and irrational a times.

That's helpful information.

What your wife presents with looks more like a bipolar affective disorder with psychotic symptoms. Not that it makes a lot of difference what the diagnoses is., seeing that it could also be unresolved postnatal psychosis, which would present that way as well. It's no longer a postnatal depression. 

What does your wife make of her experiences (the voices, her fluctating mood etc)? Does she recognise that she may be unwell?
The first step will be getting her to recognise that her presentation may be due to illness. The good thing is that it is treatable.

From your concern i suspect that you are already very supportive of her. That's commendable.

It's important to continue to reassure her about the fact that you have no intentions of giving up on her, even if she has a 'mental' illness. For the sake of the stigma, it's best to describe it in terms of 'stress-related experiences'.

What you guys can do together is to actually read up more about the illness. That would demonstrate to her that you are committed, inspite of her blaming you for her problems.

Here's a link to the Royal College of Psychiatrists most recent evidence-based information on postnatal mental illness for the public.
http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth.aspx

Next thing you should do is to arrange to have her seen by a Doctor, who would probably start her on a neuroleptic medication with or without a mood stabiliser. In an ideal world, she'd have been screened for possible metabolic disturbances (thyroid function, especially), and also had her electolytes and sugar level checked out by now, since you say she's already had loads of investigations.

The most wise thing to do though, would be to get her seen by a Psychiatrist, not a Psychologist.

I wish you the best and stay strong.

I know you say you have tried natural remedies but what kind?This is because once you go down the antipsychotics and antidepressant route ,the side effects in the long term can be devastating.The most common of which are the extrapyrimidal effects.Psychotherapy is good.It helps.But exhaust all your options first before opting for the synthesized drugs route.You might want to read about a herb called St.johns wort.It has been used successfully in cases of moderate to mildly severe depression.I have also had a lot of people here in Nigeria say it really works.Read it up and if ure interested then call.All the best.018738625,08060508876

Something as simple as imbalance in your wife's energy system could be responsible for her actions and behaviours. Such imbalance could result from energetic blocks due to, may be, fear from pregnancy complications, having to attend to two kids instead of one, how to manage the kid along with her husband, coping with pressure from extended family members, etc. Such imbalances can not be traced by any laboratory tests because these instruments do not capture energy fields of the type I mean here. Try an Energy Therapist to help in balancing her energy field. This can also be done through distance healing.

Please note that this is not religious healing but simply a method of manipulating the energy centres on the body to achieve balance and overcome such chalenges as depression, fear, guilt, anger, etc. You may go to Total Drugless Healing in the Health segment of this forum to read more.

Hope this helps.

@Poster
I sympathize with you and your wife, but the best advice is to see a qualified OB/Gyne for this symptoms. Is she breast feeding successfully? If no, then she may have Sheehan's syndrome: http://www.mayoclinic.com/health/sheehans-syndrome/DS00889
Visit a well trained and qualified MD for management of this case, it's actually common. Let me know if need more assistance.

Sheehan's syndrome is an interesting differential diagnosis for this case, but i am afraid it's way down on the list of differentials! In Sheehan's syndrome i'm sure most of the literature would say that the fluctuating hypomanic symptoms and auditory hallucinations, which this lady presents with would not be among the most prominent symptoms of hypopituitrism you'd find.

In an ideal world, the primary care physician would make the appropriate referral.  In my clinical experience, which includes a lot of Liaison Psychiatric work on Oby/Gyn wards what this lady needs is a Psychiatrist to review her.

@naijaking1, i'm not trying to dis you! In Medicine, you never say 'never'!

beneli:

Sheehan's syndrome is an interesting differential diagnosis for this case, but i am afraid it's way down on the list of differentials! In Sheehan's syndrome i'm sure most of the literature would say that the fluctuating hypomanic symptoms and auditory hallucinations, which this lady presents with would not be among the most prominent symptoms of hypopituitrism you'd find.

In an ideal world, the primary care physician would make the appropriate referral. In my clinical experience, which includes a lot of Liaison Psychiatric work on Oby/Gyn wards what this lady needs is a Psychiatrist to review her.

@naijaking1, i'm not trying to dis you! In Medicine, you never say 'never'!

Nothing personal!
The poster describes a post-partum condition that might have aggrevated a previous condition. Once again, if she is not lactating/not breast feeding a few days after delivary, Sheehan's is at the top of your differential and not at the bottom. That's why I queried her breastfeeding status in my write up. The poster either needs to give more history, or return to her MD.
Sheenan's usually resolves with hydration and restoration of the dopaminergic/prolactin axis. It's easy to become specialty oriented tunnel-visioned about these things, but everything involving abnormal behaviour doesn't always have a psych. origin.
Infact, more than 50% of the so-called abnormal psychiatric behaviours have organic origins that is routinely managed by M.Ds like myself.

Some of the liaison cases referred to 'MD's like myself' who are specialists in Psychiatry are actually not really supposed to be for us at the end of the day. But we still get called out or referred such for our professional opinion now and then. That's the beauty of working in a society were every body is specialised! When i worked in Naija, i managed everything and can't remember ever making a referral to a 'specialist'. But here it's different.

I'm sure that given the litiginous nature of practice where you are, a request for a Liaison Psychiatrists opinion would not be out of order in a case like this, as part of your management plans in a woman who presents with behaviour changes and fleeting psychotic symptoms that persists 3 years after her delivery.

I wish there were more MD's like yourself here in the UK! It would have made our work here a lot more easier!

But let's let it rest. We are not fighting over a patient. The man wants help and i honestly think that my advice offered to the gentleman a few posts earlier is in order. I am assuming that you missed the part where i mentioned the need to have had her screened for metabolic disturbances and also check up her electrolytes as part of the baseline investigations.

You are right the majority of Psychiatric (not psychological) problems are actually organic in origin. They are usually referred to 'MD's like myself' by their primary care physicians.  Is that what you are by any chance?

Having said that, i think that your observations are also in order. Peace.

Yes, M.Ds like myself! I wouldn't have it any other way
I know I run the risk of having my statement psychoanalysed.
Also, I think we might have misunderstood the initial presentation of this case; confusing 3-year presentation with post natal and post partum presentations.
My differential about Sheehan is obviously about post partum, not 3 years later. No question, post partum depression is a well known entity, but within post partum, and a few day after delivery speed of acurate diagnosis becomes of essence. Once again, pyschotic behaviours in a woman who is unable to breastfeed a few days post partum has Sheehan's high on the differential diagnosis.