Postpartum psychosis
Classification and external resources
Incidence of psychoses among Swedish first-time mothers
ICD-10	F53.0f50
ICD-9	Template:ICD9648.4

Postpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth.

A typical example is for a woman to become irritable, have extreme mood swings and hallucinations, and possibly need psychiatric hospitalization. Often, out of fear of stigma or misunderstanding, women hide their condition.^[1]

In this group there are at least a dozen organic psychoses, which are described under another heading "organic pre- and postpartum psychoses".^[2] The relatively common non-organic form, still prevalent in Europe, North America and throughout the world, is sometimes called puerperal bipolar disorder, because of its close link with manic depressive (bipolar) disorder;^[3] but some of these mothers have atypical symptoms (see below), which come under the heading of acute polymorphic (cycloid) psychosis (schizophreniform in the US).^[4] Puerperal mania was first clearly described by the German obstetrician Osiander in 1797,^[5] and a literature of over 2,000 works has accumulated since then. These psychoses are endogenous, heritable illnesses with acute onset, benign episodic course and response to mood-normalizing and mood-stabilizing treatments. The inclusion of severe postpartum depression under postpartum psychosis is controversial: many clinicians would allow this only if depression was accompanied by psychotic features (see below).

The onset is abrupt, and symptoms rapidly reach a climax of severity. Manic and acute polymorphic forms almost always start within the first 14 days, but depressive psychosis may develop somewhat later.

Symptoms[link]

Some patients have typical manic symptoms, such as euphoria, overactivity, decreased sleep requirement, loquaciousness, flight of ideas, increased sociability, disinhibition, irritability, violence and delusions, which are usually grandiose or religious in content; on the whole these symptoms are more severe than in mania occurring at other times, with highly disorganized speech and extreme excitement. Others have severe depression with delusions, verbal hallucinations, mutism, stupor or transient swings into hypomania. Some switch from mania to depression (or vice versa) within the same episode. Atypical features include perplexity, confusion, emotions like extreme fear and ecstasy, catatonia or rapid changes of mental state with transient delusional ideas; these are so striking that some authors have regarded them as a distinct, specific disease, but they are the defining features of acute polymorphic (cycloid) psychoses, and are seen in other contexts (for example, menstrual psychosis) and in men.

Course and treatment[link]

Without treatment, these psychoses can last many months; but with modern therapy they usually resolve within a few weeks. A small minority follow a relapsing pattern, usually related to the menstrual cycle. Mothers who suffer a puerperal episode are liable to other manic depressive or acute polymorphic episodes, some of which occur after other children are born, some during pregnancy or after an abortion, and some unrelated to childbearing. Puerperal recurrences occur after at least 20% of subsequent deliveries, or over 50% if depressive episodes are included.^[6]

Severe overactivity and delusions may require rapid tranquilization by neuroleptic (antipsychotic) drugs, but they should be used with caution because of the danger of severe side effects including neuroleptic malignant syndrome.^[7] Electro-convulsive (electroshock) treatment is highly effective.^[8] Mood stabilizing drugs such as lithium are also useful in treatment and possibly the prevention of episodes in women at high risk (i.e., women who have already experienced manic or puerperal episodes). The location of treatment is an issue: hospitalization is disruptive to the family, and it is possible to treat moderately severe cases at home, where the sufferer can maintain her role as a mother and build up her relationship with the newborn. This requires the presence, round the clock, of competent adults (such as the baby's maternal grandmother), and frequent visits by professional staff.^[9] If hospital admission is necessary, there are advantages in conjoint mother and baby admission. Yet multiple factors must be considered in the subsequent discharge plan to ensure the safety and healthy development of both the baby and its mother.^[10] This plan often involves a multidisciplinary team structure to follow-up on mother, baby, their relationship and the entire family.

Suicide is rare, and infanticide extremely rare, during these episodes. It does occur, as illustrated by the famous cases summarized below. Infanticide after childbirth is usually due to profound postpartum depression (melancholic filicide) when it is often accompanied by suicide.^[11]

Causes[link]

These are world-wide disorders. Their incidence has been carefully measured by state-of-the-art epidemiological studies, and is somewhat less than 1/1,000 deliveries.^[12] They are more common in first time mothers. As recognized by Marcé (1962), the link to menstruation, and especially menstrual psychosis, is an important clue to the cause.^[13][14] Molecular genetic studies suggest that there is a specific heritable factor.^[15] There is evidence of linkage to chromosome 16.^[16]

Famous cases[link]

Harriet Mordaunt[link]

Harriet Sarah, Lady Mordaunt (1848-1906)^[17]), formerly Harriet Moncreiffe, was the Scottish wife of an English baronet and Member of Parliament, Sir Charles Mordaunt. She was the respondent in a sensational divorce case in which the Prince of Wales (later King Edward VII) was embroiled and, after a counter-petition led to a finding of mental disorder. After a controversial trial lasting seven days, the jury determined that Lady Mordaunt was suffering from “puerperal mania”^[18] (i.e. postpartum psychosis), at the time the summons was served on her and that she was unable to instruct a lawyer in her defense. Accordingly, her husband's petition for divorce was dismissed, while Lady Mordaunt was committed to an asylum,^[19] where she spent the remaining thirty-six years of her life.

Melanie Blocker-Stokes[link]

Melanie Blocker-Stokes, of Chicago, IL, committed suicide by jumping from a building on June 11, 2001. In February 2001 she gave birth to a healthy baby girl. In the weeks following the birth of her daughter, she developed severe depression, in which (4 weeks after the birth) she stopped eating and drinking and could no longer swallow. She thought her neighbors had all closed their blinds because they thought she was a bad mother (a postpartum depressive psychosis).^[20] She was in and out of Chicago area hospitals several times over a period of a few months. Her death led to the proposal of the Melanie Blocker-Stokes Postpartum Depression Research and Care Act (H.R. 846 and S. 450), intended to expand research into the condition.^[21]

Andrea Yates[link]

Andrea Yates methodically drowned her 5 children in a bathtub in her Clear Lake City, Houston, Texas house on June 20, 2001. Her mental health began to deteriorate with the birth of each of her children, combined with other external stressors. She attempted suicide twice and was hospitalized twice in a psychiatric facility in 1999 after delivering her fourth child. Yates was warned against having any more children, but conceived approximately 7 weeks later. Three months after the birth of her fifth child and shortly after the death of her father, she began to rapidly degenerate. She was hospitalized twice more, and eventually released with orders that she should not be left alone. During an hour when her husband had left for work and her mother-in-law was scheduled to arrive, she killed all five of her children. She was consequently committed to a high-security psychiatric hospital. Her case attracted a great deal of media attention, particularly to the concept of serious mental illness following (and also caused by) childbirth. Some of this coverage proved to be problematic and misleading. For example, the National Organization for Women (NOW) initially incorrectly noted on their website that Yates had suffered from postpartum depression. The Individualist Feminists quickly pointed out that Yates suffered from postpartum psychosis, a more serious and much less common disorder, and that the clinical definition of postpartum depression does not list infanticide as a symptom.^[22][23] This misrepresentation of Yates' illness stigmatized a large number of mothers and made them less likely to seek professional help for fear of being seen as a threat to their children and consequently being committed. NOW promptly revised their statement to indicate postpartum psychosis.^[24][25]

Legal status[link]

Several nations including Canada, Great Britain, Australia and Italy recognize post partum mental illness as a mitigating factor in cases where mothers kill their children.^[26] In the United States, such a legal distinction is not currently made.^[26] Britain has had the Infanticide Act since 1922.

In 2009, Texas legislator Jessica Farrar proposed a bill that would recognize postpartum psychosis as a defense for mothers who kill their infants.^[27] Under the terms of the proposed legislation, if jurors concluded that a mother's "judgment was impaired as a result of the effects of giving birth or the effects of lactation following the birth", they would be allowed to convict her of the crime of infanticide, rather than murder.^[26] The maximum penalty for infanticide would be two years in prison.^[26]

See also[link]

• Psychiatric disorders of childbirth
• Postpartum depression

References[link]

Jessica Rowe
Born	Jessica Rowe 1971 (age 40–41) Sydney, New South Wales, Australia
Residence	Sydney, Australia
Occupation	Seven News & Weekend Sunrise presenter
Employer	Seven Network
Known for	Ten News (1996 – 2005) Today (2006) Seven News (2007 – present) Weekend Sunrise (2010 – present)
Spouse	Peter Overton
Children	Allegra Penelope Overton (born (2007-01-18) 18 January 2007 (age 5)) Giselle Charlotte Overton (born (2009-04-09) 9 April 2009 (age 3))
Website
Jessica Rowe

Jessica Rowe (born 1971) is an Australian television news presenter. Rowe attended Sydney Girls High School^[1] in Sydney, and completed a Communications degree at Charles Sturt University in Bathurst. During her studies she was a broadcaster with on-campus community radio station 2MCE-FM. In April 2011, Jessica appeared as the Narrator in Side By Side By Sondheim at the Seymour Centre in Sydney.

Biography[link]

Early career[link]

At 22 years old, Jessica started her career at Channel Nine as a receptionist for Nine's Wide World of Sports. She made her on-air debut as a weather presenter on Prime Television in Canberra. She was later spotted by Network Ten executives, and was made a main news presenter. She presented Ten Sydney's flagship Ten News at Five bulletin with Ron Wilson for almost 10 years, from 1996 until the end of 2005.

[edit] Today

In 2005 Rowe signed a contract valued at $500,000 to host the Nine Network's Today, which she briefly co-hosted with Karl Stefanovic from late January until early December 2006. Ten took Rowe to court over her defection, claiming that a clause in their contract with Rowe prevented her from starting at Nine until June 2006. The case was dismissed on 30 December 2005, allowing Rowe to debut on the show 30 January 2006.

Rowe's early tenure with the Nine Network's Today was disastrous. There was public criticism of her presentation style on this breakfast television show, a style which was perceived by many as "annoying".^[2] Additionally, Rowe was embarrassed on 30 May 2006 by a gaffe in which Australian Brigadier Michael Slater revealed during a live cross that the interview from Dili, East Timor was being stage managed.^[3][4] Nine Network CEO Eddie McGuire made a public statement in June 2006 falsely stating the claims Rowe was to be "sacked" were part of a "a malicious and unprecedented vilification campaign"^[5] This followed the sworn evidence in an affidavit from Nine's former head of news Mark Llewellyn that McGuire had threatened to "bone" Jessica Rowe during a meeting with executives^[6] On 26 July 2006, she fell down six stairs at her Sydney home and suffered a broken wrist, but her unborn baby was uninjured.^[7] She went back to work on Today on the following Monday.^[8]

On 6 May 2007, it was announced that Rowe had left the Nine Network due to "payment disputes".^[9]

Seven Network[link]

The Sydney Morning Herald had reported on 23 July that Rowe would return to television as a news presenter for Seven News. She was also a contestant in the seventh series of Dancing with the Stars.^[10]

Jessica began her presenting duties on 17 December 2007 with the national Seven 4.30 News news bulletin. In January 2008, Rowe presented Seven Morning News while Ann Sanders was on leave and she also filled in for Natalie Barr on Sunrise.

From February 2008, Rowe began a stint as a panelist on a new late night show on Seven's high definition channel (7HD) called The NightCap.^[11] This proved to be a further career failure for Rowe. The show has since stopped production due to no generation of revenue for Seven

On 15 December 2008, News Limited reported that Rowe's contract with the Seven Network had not been renewed. The head of the network, David Leckie, confirmed that her contract had ended and that Seven was unable to offer her a permanent news presenter position, although he said that casual news presenting shifts may become available for her.^[12]

In December 2010, Rowe began presenting the news on Weekend Sunrise replacing Sarah Cumming and Sharyn Ghidella.

Personal life[link]

Rowe is married to Australian television journalist and Nine News and 60 Minutes presenter Peter Overton.

On 21 July 2006, Jessica Rowe announced on Today that she was 3½ months pregnant. Further, in an interview with the Australian Women's Weekly of 22 August 2006, she said that her baby was due on 22 January 2007. The baby was conceived after four IVF attempts.^[13] She began maternity leave from Today on 8 December 2006. Sarah Murdoch was her temporary replacement, however presented the show longer than originally intended.^[14] Kellie Connolly replaced Murdoch, and was eventually replaced by Lisa Wilkinson.

Rowe gave birth to daughter Allegra Penelope Overton on 18 January 2007, four days ahead of the due date. She later admitted that she had suffered from post-natal depression during Allegra's early months, in the hope of helping other mothers in the same situation.^[15]

In October 2008, Rowe announced that she was 14 weeks pregnant with her second child and that it has been conceived naturally. On 9 April 2009, Rowe gave birth to daughter Giselle Charlotte Overton, Peter Overton announced the news on 10 April.

She is a fan of the Sydney Roosters Rugby League Team.

References[link]

External links[link]

• Jessica Rowe at the Internet Movie Database
• Jessica Rowe
• "Jessica Rowe - My Best Times" in Good Medicine magazine, October 2004
• "Out of the darkness" Sixty Minutes, 29 February 2004