“Is this my baby?”: A literature review on puerperal psychosis in Africa

Abstract

Puerperal psychosis although rare is a severe form of psychiatric mental illness with very serious implications such as infanticide and suicide. The symptoms are usually present within the first two to three days after delivery and if close attention is paid a prompt diagnosis will be made. Patients who are treated early have been observed to make full recovery. This literature review hopes to discuss the meaning of puerperal psychosis, its epidemiology, etiological factors, management and prevention.

Materials and Methods: The materials used in this review article come from studies and publications on puerperal psychosis from PubMed, PsycINFO, Google Scholar, Science Direct, Biomed central and Medline 2009 to 2019.

Results: The data suggest that puerperal psychosis occurs in 2-3/1000 of African women within the first 2-4 weeks post-delivery. The incidence, onset and pattern of illness in Africa are all remarkably similar to that described in the international literature. It is associated with hormonal changes accompanying child birth which in turn leads to changes in mothers’ moods and emotions. Other risk factors are primiparous patient; a family history of psychiatric illness; and a personal psychiatric history, particularly a history of mania and substance dependence. Symptoms range from depression to frank psychosis with grossly disorganized behavior which result in poor insight which can lead to devastating effects on the mother and newborn. A high index of suspicion, prompt attention and treatment based on patients’ symptoms can reduce its menace. Patients with family history of mental illnesses or puerperal psychosis will benefit from early social support, psychotherapy, repetitive assessment of mothers’ symptoms and estrogen prophylaxis to reduce the incidence of puerperal psychosis.

Conclusion: Timely accurate assessment and appropriate treatment of puerperal psychosis will significantly improve the prognosis, promote full recovery and reduce morbidity and mortality of mother and baby.