Puerperal mental illness

S’IP:T,ECTE:I)

z\RRl'K,\(!l'S

Puerperium Hemphill,

R. E.:

Paerperal

Mental

Illness,

131-i!. hl. .I. 2:

I)CY-. ti, 195%

The editorial is concerned \vith the :rt~Ii~lc l)y JJr. le. I(:. Hemphill in the Dee. ci, 1952, issue of the Uritish Dfec7icaZ JfmViucZ on :L stutlp of puerpcral mental illness. The incidence makes this a complication of pregnancy of considerable importance. The editorial indif confusional states or toxic delirium, and cates the room for improvement in prevcntin that these conditions should be treated in a sllecial unit. of a lying-in hospital since they are orgaaie and not affective or schizophrenic reactions. The importance of early recognition is emphasized. Two findings of Hemphill’s report are of special interest: first, the occurrence of depressive states which rcsem blc the involutional st,ates of later life; and, If puerperal schizophrenia follows second: the poor prognosis for schizophrenic patients. a course different from other forms of the disease, t,hen it should be considered an entity by itself and further investigation into its pathogenesis is of utmost importance. DONALD

Hemphill, Pee.

R. E.: 6, 1952.

Incidence

and

Nature

of

Puerperal

Psychiatric

Illness,

G. Jomsc~

Brit.

M.

J. 1:

The author has reported on a study of case records of patients delivered at maternity hospitals in Bristol to determine the importance of physical and psychological factors in t,he development of mental disease. All cases of mental illness related to pregnancy or the puerperium admitted to mental hospitals during the same IO year period were studied. Only the cases with considerable mental unbalance were included in the study. The incidence of mental reactions in the maternit.y hospital cases was 1.7 per 1,000, of which 1 per 1,000 was admitted to mental hospitals. The inritlemc~ of mental illness ill the total number of delivered patients was 1.4 per 1,000. The cases were classified ultimately into affective (including manic-depressive Cases and puerperal depression), schizophrenic (including mixed schizophrenic cases), and other cases (including neurosis, confusion and exhaustion, toxic delirium, etc.). With respect to etiological factors, I3 per cent had a history of previous mental illness; there was a positive family history in 14.5 per cent of all cases, but in 25 per cent of the schizophrenic group. There was no evidence that parity-, age, multiple births, physical illnesses, or psychological factors played any role in the etiology of mental illness. The personalities of those suffering from puerperal depression and mixed schizophrenic reactions were characterized as dependent, overanxious, obsessional, and rigid in type. Delirium and reactions to exhaustion and toxemia as well as manic-depressive episodes do not differ from those not related to pregnancy. The author believes that there is a psychiatric entity called lmerporal depression which differs from manic-depressive psychosis, but resembles involutional melancholia. It makes its appearance within the first two weeks post partum; it is extremely intractable even when treated by convulsive therapy. Eventual recovery or spontaneous remission is usual. The prognosis in schizophrenia was practically hopeless. The author suggests that the sudden deprivation of the placenta and its normal hormone cont,ent produces a disturbance in the endocrine equilibrium which, working on a predisposed constitution, produces the mental illness. The author believes that therapeutic interruption of pregnancy should be seriously eonsidcred if less than a year has elapsed since i’ecovery from a puerperal psychosis which ran a prolonged course, if there is a bad family history of mental illness, and if there is a history of more than one attack of puerperal psychosis. He feels t,hat it is very dangerous to allow a patient having recovered from puerperal schizophrenia to become pregnant again, The author believes that good antenatal care may do much to reduce psychoneurotic and mild nervous reactions, but that nothing can be done to prevent puerpersl depression or puerperal schizophrenia. DONALD

G. JOHNSOX