doctorkk1:

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadvertently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illness?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) Is she taking any medications?
(continued below)

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Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist. This would be more emergent, if she is incorporating her baby into her unusual beliefs.
I know she may have difficulty assessing help if based in Nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadvertently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illness?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) Is she taking any medications?
(continued below)

Hi Rosejen,
Sorry for getting back to you late my messages weren't getting uploaded, so i have decided to format them into multiple postings. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) What medications is she taking?
(continued below)

hi dominique,
i have been trying to post a response to an issue raised by a fellow nairalander, but my message doesn't appear. I will try and shorten it, probably this would help.

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadvertently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illness?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) Is she currently on any medications?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferably a psychiatrist. It becomes more emergent, if she is incorporating her baby in her abnormal belief system.
I know it may be difficult to asses help, if she is based in Nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on medications called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i dididn't confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
I have not forgotten to complete my post, but i am having difficulty on this site. I will try again tomorrow.

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist.
If she is resident in nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i didn’t confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist.
If she is resident in nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i didn’t confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist.
If she is resident in nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i didn’t confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

rosejen:

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

The good news is that puerperal psyhosis is not the same thing as schizophrenia. Most patients with Puerperal psychosis recover fully from their illness.
My advice is that she is taken to a hospital with where she would be comprehensively assessed.
She will need to have blood tests to make sure her symptoms are not due to a physical cause such as - retained products, acute confusional state, side effects of medications, thromboemblic event etc. These need to be excluded before we can confidently diagnose puerperal psychosis.

She will need a lot of support from her husband and family members.
The family will also need to be educated on this condition, so, they can cope better.
She will need practical support with feeding the baby, washing, nappy changing etc.
She will benefit from medications called antipsychotics e.g. olanzapine, quetiapine, amisulpiride
If depressed, then she will need to be on antidepressnats e.g. citalopram, sertraline.
These will usually be started either by a psychiatrist or family doctor.

I have attached two links containing more educational leaflets
://www.puerperalpsychosis.org.uk/site/conditions/psychosis.html
http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/postnatalmentalhealth/postnataldepression.aspx

I hope these will help and don't hesitate to contact me, if you have more queries.

rosejen:

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

Hi Rosejen,
Thanks for getting in touch.
From the brief history you've given, your cousin seems to be suffering from Puerperal Psychosis.
This is a condition that occurs in women shortly after birth. It usually starts within a few weeks or even months after childbirth.
It can really be confusing especially to the family and partner who struggle to care for both the mother and her baby.
It occurs about 1 in per 500 births.
The exact cause is unknown, but tends to recur in pregnancy i.e. is someone has it, there is a higher likelihood of recurrence in subsequent pregnancies. It is commoner in individuals with a history of bipolar disorder or family history of postnantal illness or those experiencing severe stress.

The common feautures are bewilderment, perplexity, disorientation and confusion. They can start talking to themselves, hearing voices (auditory hallucinations) seeing imaginay things (hallucinations) and become paranoid (suspicious).
Some can become overly concerned about their children. They would worry about the child's health, and even believe the baby is either deformed or even possessed or that people are planning to steal new born baby and it has led to some mothers actuallly harming their children (rare).
I will discuss the treatment in my next post.

Thanks MadamL and Dominique. I can't be discouraged by Snowdrops cynical remarks. I have seen a few threads on depression, anxiety, schizophrenia and other psychiatric conditions and felt i may be able to offer support and advice where appropriate.
I presume snowdrops is unaware of the huge impact of mental health burden on the society as a whole.

Hi Fellow Nairalanders,
I am a United Kingdom based psychiatrist working for the National Health Service (NHS).
I would be happy to addreess your concerns and give support on issues of mental health.