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Ask the Mental Health Expert Archives 2001-2004

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Postpartum Causes Bipolar-Schizophrenic?

Q. My sister-in-law had a premature baby on 11/8/01 at 24 1/2 weeks. The baby weighed 1 pound 13 ounces and is doing well, but at first it was very critical and is still very serious. She had never had any kind of mental illness before and I have known her since she was 14 years old and she is now 33.

We had to put her in the hospital on Thanksgiving day and she has been diagnosed as bipolar-schizophrenic. This has been such a shock to all of us in our family since she has always been so normal (whatever that means). Could postpartum bring on such a change due to the trauma of the premature delivery? I know she was extremely worried every day for the first couple of weeks after the baby was born and now she seems to be in denial of his existence most of the time?

A. This is clearly a very difficult time for you and your sister-in-law. While I can't comment directly on her diagnosis, I can say that schizophrenia would be quite unlikely to show up for the first time at age 33. The onset of schizophrenia is much more commonly seen in late adolescence and young adulthood (ages 14-25). Much more likely is some kind of mood disorder related to the postpartum period. First of all, it's important to realize that mild depression after the birth of a child--so-called postpartum blues--is quite common, affecting as many as 50-65% of new mothers.

They will commonly report irritability, mild mood swings, and episodes of crying, usually reaching their peak within the first week after the birth. In contrast to the blues, some women develop a more serious condition called postpartum depression (PPD). This usually occurs within the first six months after the birth, and may affect as many as 7% of new mothers. PPD appears to be more common in women who have a history of bipolar disorder--so-called manic-depressive illness--but can appear in women with no previous psychiatric history. PPD is more than just blues--the woman often feels hopeless, helpless, woefully inadequate, irritable, tearful, and even suicidal. Sometimes, psychotic features are present, such as paranoid delusions or auditory hallucinations. (This does not indicate schizophrenia).

The mother may harbor angry or even destructive thoughts toward the new baby, and is in need of immediate treatment. Antidepressant medication may be very helpful for women with PPD, sometimes combined with an antipsychotic or mood-stabilizing medication. Getting into psychotherapy is also important, once the acute condition has been brought under some control. Finding social supports, either in a group or via organizations that help new mothers with PPD, is also helpful. With appropriate care and treatment, the outlook for women with PPD is generally good. I hope this proves the case with your sister-in-law.

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February 2002

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