What is mommy doing in the bathroom? A typical case of postpartum psychosis

Abstract

Objective

We report the case of a 41-year-old woman brought by her husband for behavioral disorder during the last week. As background, she had her first vaginal delivery after a risky pregnancy a fortnight ago, which required uterine arteries embolization for intense uterine bleeding; and an adjustment disorder eight years ago.

Results

The patient presents a wordy and inadequate speech, as well as insomnia for the last seven nights. She has injuries in both of her hands due to intensive cleaning of her home and genitalia. Her condition is fluctuant, remaining for hours in the bathroom after breastfeeding and behaving strangely at night, with an irritable mood and being unable to care for their child.

She also has a fever of 39 °C, with thrombocytosis (850,000 platelets) and a c-reactive protein up to 20 as relevant alterations, attributed to mastitis and consequences of the recent intervention. Olanzapine at a dose of 10 mg per day was introduced after stopping breastfeeding, with very good tolerance and complete clinical remission within a few days, with the diagnosis of postpartum psychosis and suspected affective disorder of the bipolar spectrum.

Conclusions

Puerperal psychosis is misdiagnosed in at least 50% of cases, with a prevalence of 1–2/1000 births, and appears more frequently between the 3rd and 9th day after delivery. The risk for both mother and child is severe and it must be treated immediately, being its evolution in general favorable. Most of the risk factors and clinical manifestations for this condition are described in this case.

Disclosure of interest

The authors have not supplied their declaration of competing interest.