The Nature of Puerperal Psychosis at Muhimbili National Hospital: Its Physical Co-Morbidity, Associated Main Obstetric and Social Factors

Noah K Ndosi(1), MLW Mtawali(2),


(1) 
(2) 
Corresponding Author

Abstract


Eighty six in-patients suffering from puerperal psychosis within six weeks after childbirth were prospectively investigated in Muhimbili National Hospital during two years. Formal psychiatric history, mental status evaluation, research and diagnostic criteria including ICD 10 and clinical progression were employed for diagnosis. Using a structured questionnaire, the socio-demographic characteristics, concomitant physical disorders, major obstetric events, period of onset of puerperal psychosis following delivery and social support given were established. Mean age was found to be 23.6 years; the majority was primiparous women with parity of between one and three children. Main physical co-morbidities included anaemia in 51.4% of cases, infections in 44.2% and EPH-gestosis in 17.4%. Most mothers received social support from their extended families. Organic psychosis was found in four fifths of the mothers and schizophrenia in 8.1%. A high rate of early onset puerperal psychosis (3.2/1000 births), predominantly in young primiparous women, was found. (Afr J Reprod Health 2002; 6[1]: 41–49)

 

Keywords: The nature of puerperal psychosis Muhimbili National Hospital


References


Bright DA. Postpartum mental disorders. Am Fam Physician 1994; 50(3): 595–8.

Christie JH, Keay SD, Morgan M, et al. Puerperal sepsis: a disease of the past. Brit J ObstGyn 2000; 108(1): 127.

Robling SA, Paykel ES, Dunn VJ, et al. Long-term outcome of severe puerperal psychiatric illness: a 23-year follow-up study. Psychol Med 2000; (6): 1263–71.

Oosthuizen P, Russouw H and Roberts M. Is puerperal psychosis bipolar mood disorder? A phenomenological comparison. Compr Psychiatry 1995; 36(1): 77–81.

Terp IM and Mortensen PB. Postpartum psychoses. Clinical diagnosis and relative risk of admission after parturition. Br J Psychiatry 1998; 172: 521–6.

Kumar R. Reproduction and psychiatric disorders in women. In: M. H. Lader (Ed.). Handbook of Psychiatry, Mental Disorders and Somatic Illness. New York: Cambridge University Press, 1983, 67–72.

Okano T, Nomura J, Kumar R, et al. An epidemiological and clinical investigation of postpartum psychiatric illness in Japanese mothers.J ofAffective Disorders 1998; 48(2): 233–240.

Inwood DG. Postpartum psychotic disorders. In: HI Kaplan and BJ Sadock (Eds.). Comprehensive Textbook of Psychiatry. 5th edition. Williams & Wilkins 1989, 853–58.

WHO. 10th International classification of mental and behavioural disorders. Geneva: WHO, 1992.

Cohen LS. Postpartum psychiatric disorders. ActaPsychiatrScand 1995; 9167–69.

Smiths ST. Psychotic manifestations. J Affective Disorders 1995; 34(2): 101–4.

Kendell RE, Chalmers JC and Platz C. Epidemiology of puerperal psychosis phenomena and diagnosis. Arch Gen Psychiatry 1981; 38: 829–31.

Deuchar N and Brockington I. Puerperal and menstrual psychoses: the proposal of a unitary aetiological hypothesis. J PsychosomObstetGynaecol 1998; (2): 104–10.

Ahokas A, Aito M and Turiainen S. Association between oestradiol and puerperal psychosis. ActaPsychiatriScand 2000; (20): 167–9.

Singh I and Kaur V. Puerperal psychosis — analysis of 35 cases. Indian Med Assoc 2000; (5): 217–8.

Howson CP, Harrison FP, Hotra D, et al. In Her Lifetime. Washington DC: Institute of Medicine, National Academy Press, 1996, 147–8.

Endicott J and Spitzer RL. A diagnostic interview with the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1978; 35: 837–39.

Ndosi NK and Kisesa AF. Causes of mortality among mental in-patients at Muhimbili Medical Centre, Dar es Salaam. E Afr Med J 1977; 74: 23–26.

Kendell RE and Charmers JC. Epidemiology of puerperal psychosis. Br J Psychiatry 1987; 150: 662–3.

Turkson SN. Psychiatric diagnosis among referred patients in Ghana. EAfr Med J 1998; 75: 336–8.

Ndosi NK. Mental disorders in Tanzania: a cultural perspective. In: Ihsan Al-Issa (Ed.). Handbook of Culture and Mental Illness.An International Perspective. International University Press, Inc., 1995, 85–91.

Tanzanian Demographic Health Survey, 1996, 11–37.

Mujinja P. Poverty and health: socio-economic and political determinants of health. Scientific paper presented at TPHA conference, Nov. 1997.

Black D. Inequality in health: A report of the Department of Health and Social Security, London, 1980.

Joffe M, Chapple J, Paterson C, et al. What is the optimal caesarean section rate? An outcome-based study of existing variation. J Epidemiol Community Health 1994; 48: 406–11.

Ifabumuyi OI and Akindele MO. Postpartum mental illness in Northern Nigeria. ActaPsychiatrScand 1980; 83: 64–65.

Swift CR. Psychosis during puerperium among Tanzanians. East Afr Med J 972; 49: 652–657.

Kerse MJNC and Kanhai HH. Induction of labour: fetal death. In: Chalmers I (Ed.). Effective Care in Pregnancy and Childbirth. 1990; 1118–28.

Singh T and Kaur V. Puerperal psychosis — analysis of 35 cases. J Indian Med Assoc2000; 98(5): 217–8.

Allwood CW, Berk M and Bodemer W. Investigation into puerperal psychosis in black women admitted to Baragwanath Hospital. S Afr Med J 2000; 90(5): 518–20.

Priest RG. Psychiatry in Medical Practice. Macdonald and Evans, 1982, 427.

Best B. Acute psychiatric disturbances in pregnancy and the puerperium. Pract Res ClinObstetGynaec 2000; 14(1): 73–87.

Massawe SN. Maternal mortality in Muhimbili Medical Centre. Dissertation, University of Dar es Salaam, 1993.

Meyer JW and Eichorn. Does recombinant human erythropoietin not only treat anaemia but also reduces postpartum emotional distress well? J Perinat Med 1995; 23(1,2): 99–109.

Salaam SA and Kilzeih N. Lorazepam treatment of psychogenic catatonia. An update. J Psychiatry 1998; (49): 16–24.

Robertson EE and Kennedy RI. Organic disorders. In: RE Kendell and AK Zealley (Eds.). Companion to Psychiatric Studies. 3rd edition. Churchill Livingstone, 1983, 239–274.

Mutabingwa TK. Malaria in pregnancy: epidemiology, pathophysiology and control options. Acta Tropical 1994; (57): 239– 254.

Muhimbili Maternity Ward Established Database, Jan–Dec., 1998.

Susser E, Colson P and Jandrof L. HIV infection among young adults with psychotic disorders. Am J Psychiatry 1997; 48(2): 237–8.

Reece EA, Hobbins JC and Mahoney MJ. Medicine of the Foetus & the Mother. Philadelphia: J.B. Lippincott Company, 1992.

Rutter M. Meyerian psychobiology, personality development and the role of life experience. Am J Psychiatry 1986; 145: 1077–1087.

Ndosi NK. The challenges of psychiatry amidst economic deprivations and social change in Dar essalaam city, Tanzania. In: J Lugalla and K Heggenhougen (Eds.). Social Change and Health in East Africa (in press).

Agrawal P, Bhatia MS and Malik SC. Postpartum psychosis: a clinical study. Int J Soc Psychiatry 1997; 4(3): 217–22.

Kumar R, Marks M, Platz C, et al. Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions. J Affect Disord 1995; 11(1): 11–22.

Pfuhlmann B, Franze E, Beckmann H, et al. Long-term course and outcome of severe postpartum psychiatric disorders. Psychopathology 1999; 32(4): 192–202.

Acuda SW and Ovuga EBL. Psychiatric disorders in a general provincial hospital in Kenya. E Afr Med J 1985; 62(4): 229– 32.

Rwegellera GC and Mwambe CC. Diagnostic classification of first ever admissions to Chainama Hills hospital, Lusaka, Zambia. Br J Psychiatr 1977; 130: 573–77.

Klompenhouwer JL and van Hulst AM. Classification of postpartum psychosis: a study of 250 mothers and baby admission in the Netherlands. ActaPsychiatrScand 1991; 84(30): 255–61.

Bagedahl-Strindlund M and Ruppert S. Postpartum mental illness; a long-term follow-up study. Psychopathology 1998; 31(5): 250–91.

Ranzuni AC, Vinekar AS and Houlihan C. Puerperal psychosis mimicking eclampsia. J MaternFetal Med 1996; 5(1): 36–8.

Dobie SA and Walker EA. Depression after childbirth. J Am Board FamPract1992; 5: 544–5.

Marks MN, Wiech A, Checkley SA, et al. Life stress and postpartum psychosis: a preliminary report. Br J Pschiatry 1991; 10(Suppl): 45–9.

Coyle N, Jones I, Robertson E, et al. Variation at the serotonin transporter gene influences susceptibility to bipolar affective puerperal psychosis. Lancet 2000; 356(9240): 1490–1.

Videbech P and Gouliaey G. First admission with puerperal psychosis 7–14 years of follow-up. ActaPsychiatrScand 1994; 91(30): 167–73.

Brockington IF. Conference proceedings notes, 6th Marce Society Conference, Herriot-Watt, 2nd–4th September 1992.

Craddock N, Brockington I, Mant R, et al. Bipolar affective puerperal psychosis associated with consanguinity. Br J Psychiatry 1994; 164(3): 359–64.


Full Text: XML

Article Metrics

Abstract View : 493 times
XML Download : 334 times

Refbacks

  • There are currently no refbacks.