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Bipolar mood disorder (manic depression)

Bipolar mood disorder affects 1–3 per cent of the population, and the first presentation of this illness for women is not uncommon when the first childis born. Although only 1–2 in1000 women will develop this condition postnatally,it causes major disruption when it does appear. An illness episode ofthis type following childbirth is known as ‘puerperal psychosis’.

In those who are vulnerable, symptoms are likely to appear within days of childbirth. The following is a typical picture, with mania first and then depression. A woman will be highly energetic, and find it hard to concentrate on one task, with poor attention span. She sleeps little, may be delusional with elated or irritable mood. Almost all of these symptoms will interfere with parenting, and the medications likely to help will go through in breast milk, raising further dilemmas in the care of her infant. It is often the first time that a woman has had this illness, and so the combined pressures offirst-time parenting and first-illness episode can place a major adjust men strain on the woman, her partner and all close family.

The natural history of the illness is for the manic phase to pass after some weeks, usually to be followed by a profound depression, which untreated canpersist for months. The person will now have little energy, disturbed sleep and appetite, no motivation or pleasure in life and a very depressed mood.Suicidal thoughts and behaviours may be an issue. Infanticide is a risk at either mood phase, and is usually associated with delusions.

Although the mood changes will eventually settle, recurrences during thewoman’s lifetime can be expected in 80 per cent of sufferers, and the risk of relapse with each subsequent pregnancy is usually quoted as about 50 percent. Effects on infants will vary depending on the symptoms present, thetreatment path chosen and the influence of other caregivers. Generally, it is believed that provided safety factors are ensured, infants and mothers benefitby keeping mother and infant together. There are fewer studies of mother–infant interactions in this condition than with schizophrenia, and thestudies are not all consistent. While Persson-Blennow et al. (1986) describeda more negative interaction in women with this type of condition whencompared with normal controls, Hipwell et al. (2000) found that a manicepisode of illness was related to secure attachment, whereas psychotic ornon-psychotic depressions were related to insecurity.

Early in the course of the illness, in the first weeks of the baby’s life, a woman may be so disorganised that she cannot concentrate sufficiently to feed herinfant. Others must help her make decisions about the adequacy of care offered her infant, taking into account safety factors. Women with a psychoticillness, whether of this variety, schizophrenic or other, have been known to act on their delusions.

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