International Journal of Research in Medical Sciences
Ahuja SK et al. Int J Res Med Sci. 2018 Jan;6(1):106-109
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175503
Original Research Article
Post-partum psychosis: socio-demographic and obstetric profile
Sunil Kumar Ahuja, Nimisha Mishra*, Pradeep Kumar
Department of Psychiatry, SS Medical College Rewa, Madhya Pradesh, India
Received: 18 November 2017
Accepted: 24 November 2017
*Correspondence:
Dr. Nimisha Mishra,
E-mail: [email protected]
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Better knowledge of socio-demographic profile and obstetric features may help in early identification
and treatment of patients with post-partum psychosis. The aim of present research is to study the age, parity, socio-
demographic and obstetric and menstrual profile of patients suffering from post-partum psychosis. Setting and
Design: A cross-sectional study at in-patient department of psychiatry, SS Medical College and associated SGMH
Rewa.
Methods: The study was conducted on sixty patients of post-partum psychosis admitted in psychiatry ward. Detailed
socio-demographic characteristics, obstetric and menstrual profile along with psychiatric assessment were recorded in
proforma specially designed for the study.
Results: Bulk of our post partum psychotic subjects (60%) were in the age range of 18-25 years with 83.33% of
women were residing at rural areas. Most of subjects (76.67%) of post partum psychosis were illiterate. 73.33%
patient were belonging to low socio-economic status and remaining to middle and high socioeconomic status.
Majority of subjects (13.33%) were house wife (86.67%) followed by laborer class. Family jointness reveal 80% and
20% of subjects trailed from joint and nuclear family respectively. the maximum number of subjects (60%) were
primipara with only 13.33% of subjects had history of obstetric complication in form of prolonged labour and post-
partum heamorrhage. 25% subjects had cesarean delivery. 40% patients of puerperal psychosis were having menstrual
irregularity and 60% had regular menstruation.
Conclusions: Screening of vulnerable groups i.e. younger age, primipara, history of irregular menstruation in post
partum period for psychiatric sign and symptoms is requisite for early diagnosis and prompt and adequate
management. As most of the patients were from rural areas it is necessary to establish psychiatric services in rural
areas as well so that this group of population can be provided holistic care along with already existing medical
services.
Keywords: Menstruation, Obstetric, Post-partum psychosis, Socio-demographic
INTRODUCTION approximately 0.1%.4,5 Post-partum psychosis is a
medical emergency condition with risk for suicide and
The perinatal period is associated with an increased risk infanticide.6,7 Early detection and treatment of mental
of several mental disorders.1 During this period many disorders are essential for family functioning and parent
susceptible women may experience diverse range of child relationship and prevention of various short term
mental health problems including Depression anxiety and and long term complications.8 Faster recognition requires
psychosis.2,3 Of these postpartum psychosis is severe good knowledge of illness. Thus, the observations of
form of mental disorder with incidence rate is present study will help in enhancing the pool of
International Journal of Research in Medical Sciences | January 2018 | Vol 6 | Issue 1 Page 106
Ahuja SK et al. Int J Res Med Sci. 2018 Jan;6(1):106-109
knowledge regarding various risk factors associated with of subjects. On menstrual history parameter 40% patient
post partum psychosis, which would guide in searching revealed irregular menstruation and remaining 60%
of various etiological factors associated with post partum subjects had regular menstruation.
psychosis.
Table 1: Socio-demographic variables in terms of
METHODS frequency and percentage (n=60).
The present study consisted of 60 patients diagnosed Patients (n=60)
Age (in years)
using ICD-10 criteria and was selected from the patients Number %
admitted in the female psychiatry ward of Sanjay Gandhi 18-25 36 60
Memorial hospital, Rewa (MP) presenting with 26-35 20 33.33
psychiatric manifestations in post partum period. >35 4 6.67
Total 60 100
Women between 15 to 40 years of age, with full term Socio-economic status
pregnancy or full term caesarean section having first High 4 6.67
episode of post partum psychosis with an onset within six Middle 12 20
weeks of delivery were included in this study. Low 44 73.33
Total 60 100
Women with emergence of abnormal behavior within Occupation
three days of delivery, presence of overt neurological House wife 52 86.67
disorder e.g. meningitis, encephalitis; seizure disorder etc Labourers 8 13.33
and having gross physical illness were excluded to Total 60 100
remove elements of confounding. Domicile
Rural 50 83.33
Detailed socio-demographic variables were recorded.
Urban 10 16.67
Menstrual and obstetric history was obtained regarding
Total 60 100
number of conception and number of deliveries,
Family type
menstrual regularity and obstetric complications.
Joint 48 80
RESULTS Nuclear 12 20
Total 60 100
In the above mentioned study, 60 diagnosed cases of post Education
partum psychosis following the inclusion criteria were Illiterate 46 76.67
enrolled in to the study. Patient’s socio-demographic Up to class V 6 10
variables (age, sex, socio-economic status, occupation, VI-VIII 4 6.67
domicile, family type, and education) and obstetric and IX to final 4 6.67
menstrual profile (type of delivery, parity, obstetric Total 60 100
complications, and menstrual history) were studied.
Table 2: Obstetric and menstrual profile of women
Bulk of our post partum psychotic subjects (60%) were in with post-partum psychosis (n=60).
the age range of 18-25 years. 73.33% patient of puerperal
psychosis were belonging to low socio-economic status Patients (n=60)
Obstetric and Menstrual profile
and remaining to middle and high socioeconomic status. Number %
Majority of subject of post partum psychosis were house Parity
wife (86.67%) followed by laborer class (13.33%). Primipara 36 60
83.33% of women were residing at rural area. Family Ii parity 16 26.67
joint ness reveal (80%) and (20%) of subjects trailed Multipara 8 13.33
from joint and nuclear family respectively. Most of Total 60 100
subjects of post partum psychosis were illiterate Obstetric complications
(76.67%). Prolonged labour 4 6.67
Postpartum haemorrhage 4 6.67
On similar line obstetric and menstrual history of Women Total 8 13.33
suffering from post partum psychosis were evaluated Type of delivery
with the results shown in Table 2. Cesarean delivery 15 25
Normal delivery 45 75
As to parity the maximum number of subjects were Total 60 100
primipara (60%), II parity were (26.67%) and multipara Menstruation
(13.33%). History of prolonged labour and post-partum Regular menstruation 36 60
haemorrhage was found in 6.67% and 6.67% of subjects Irregular menstruation 24 40
Total 60 100
respectively. History of cesarean delivery was in 25%%
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Ahuja SK et al. Int J Res Med Sci. 2018 Jan;6(1):106-109
DISCUSSION in illiterate since majority of rural females are otherwise
illiterate.
The present study was devised to investigate various
socio-demographic and obstetric and menstrual variables Parity
of patients with postpartum psychosis.
Majority of patients were primipara (60%). Present study
Age reveals that post partum psychosis is more common in
primipara and this finding also gets support from earlier
The present study indicates that most of the patients with studies.15,17,18
post partum psychosis are younger age group. The
majority of our subjects were in the age range of 18-25 Obstetric complications
years. Further as high as 60% patients developed
psychosis between 18-25 years of age as compared to In our study only 13.34% subjects are found to have
only 6.67 % above 35 years of age. This finding is obstetric complication in form of prolonged labour and
consistent with other researchers.9-11 post partum hemorrhage. Fatoye FO found obstetric
complications in 22.4% subjects.19 Study conducted by
Various biological and psychological factors could be Mc Neil TF did not support association between obstetric
responsible for an early age presentation of post partum complication and postpartum psychosis.20 Nager A
psychosis. Yet possibility that younger age group is more concluded in his study that obstetric variables have minor
vulnerable to develop acute psychosis could be another importance.21 Blackmore ER et al in their study observed
reason. that out of 167 deliveries with post partum psychosis
39.5% had delivery complications.22
Socio-economic status
Type of delivery
The larger number of our subjects belonged to low class
family (73%). Our finding is similar to past studies In current study post partum psychosis was observed
conducted by other investigators.9 Even one study found significantly higher in full term normal delivery (75%) as
that living in a poor neighborhood socioeconomic compared to cesarean delivery (25%). Hence cesarean
environment might contribute to the development of delivery does not seem to be a risk factor for genesis of
postpartum psychosis.12 post partum psychosis. Our finding is in conformity with
Conclusion from earlier studies.22,8 Regarding the
Higher occurrence of post-partum psychosis in low socio- association of cesarean deliveries with postpartum
economic status may be due to various clinical variable psychosis. Cesarean deliveries as a risk factor for post
viz poverty, long standing maladjustment of patient, partum psychosis was although proposed by few
unstable family environment, poor communication, investigators, however various other cause of acute
malnutrition etc and requires further investigation. psychosis were not considered.23
Majority of patients were housewives (86.67%) or
labourer (13.33%). We could not observe any specific Menstruation
predilection of psychosis towards any occupational
group. The large number of subjects hailed from rural The large number of subjects (60%) had regular
area (83.33%) as compared to urban area (16.67%). This menstruation however 40% subjects provided history of
finding was similar to other studies.13,14 The familial irregular menstruation. Menstrual cycle regularity and
infrastructure, intra-familial conflicts, lack of length have significant associations with specific current
communication and working habits in Indian rural set-up and life time psychiatric disorders.24
could be the contributory factor for post partum psychosis
more in rural background. Most of subjects belonged to Increased incidence of irregular menstrual cycle observed
joint family. One author found increased risk of post in patients of post-partum paychosis may be a risk factor
partum depression in joint family belongs to rural area.15 and post-partum psychosis could developed due to lack of
One of investigator suggested that in non-nuclear families rebound biochemical changes in pregnancy.25 An
culturally conditioned behavior adversely affect maternal alternative hypothesis might be that interaction of
health by compelling them to participate in household psychological and endocrine factor at end of pregnancy
activities as against the medically advised minimum makes this a particularly stressful period for precipitating
rest.16 Thus, joint family along with rural background psychosis.26 One author concluded that estradiol may
could be vulnerable factor for developing post-partum have causal relation to post partum psychosis and
psychosis. Regarding education status the large numbers significance in the treatment of this illness.27
of subjects were illiterate (76.77%). In one of study most
of the patients with post partum psychosis had no formal CONCLUSION
education.10 Although the post partum psychosis is over
represented in illiterate group, it will not be fair to Primiparity, younger age, and irregular menstruation
hypothesize that post partum psychosis is more common appears to be a significant risk factor. These subjects
International Journal of Research in Medical Sciences | January 2018 | Vol 6 | Issue 1 Page 108
Ahuja SK et al. Int J Res Med Sci. 2018 Jan;6(1):106-109
should be kept under surveillance for early identification of Pakistan. J Ayub Medical College, Abbottabad.
of post partum psychosis. Unclear Association between 2003;15(3):19-23.
post partum psychosis and cesarean delivery was 14. Ndukuba AC, Odinka PC, Nwoha. Clinical and Socio-
observed. Demographic Profile of Women with Post-Partum
psychiatric Conditions at a FederalNeuropsychiatric
Funding: No funding sources Hospital in southeast Nigeria between 2009 and 2011.
Conflict of interest: None declared Ann Med Health Sci Res. 2015;5(3):168-72.
Ethical approval: Not required 15. Shrestha N, Hazrah P, Sagar R. Incidence and
prevalence of postpartum depression in a rural
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Cite this article as: Ahuja SK, Mishra N, Kumar P.
Post-partum psychosis: socio-demographic and
obstetric profile. Int J Res Med Sci 2018;6:106-9.
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