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[Suicidal and infanticidal risks in puerperal psychosis of an early onset].
MedLine Citation:
PMID:  23055307     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: A sample of patients with a puerperal psychosis of an early manifestation is investigated in respect of special risks of suicide and infanticide.
METHODS: During a 20-year period 96 patients who had been fallen ill with a puerperal psychosis within four weeks after delivery were admitted to a psychiatric university hospital. Patients with an acute exacerbation of a known schizophrenic disorder were excluded. In a subgroup of 37 patients states of a previous (affective, bipolar affective) psychotic illness were recorded already before the puerperal index episode, in a subgroup of 59 patients puerperal psychosis was the first manifestation of a psychotic illness. Suicide- and infanticide-relevant psychopathological symptoms were analysed (suicidal ideas/behaviour before/during inpatient treatment, general disorganized aggression, psychotic anxieties related to baby, infanticidal obsessions, aggressive ideas/behaviour towards baby, neglect, infanticidal impulses).
RESULTS: Puerperal psychoses were distributed to the diagnostic categories of psychotic depressive disorder, bipolar affective disorder, and schizoaffective disorder. Six patients died due to suicide, tragically already some few days till weeks after discharge from psychiatric hospital, despite a pronounced or even complete remission of puerperal psychotic symptoms at the time of discharge. Three patients committed an extended suicide attempt that resulted in two infanticides. All isolated and extended suicides were committed in a state of depressive mood and presumably synthymic delusion.
CONCLUSIONS: Suicidal ideas and behaviour play a major role in patients with puerperal psychosis before and during inpatient treatment. An increased risk for mothers and babies may persist, however, even after a seemingly good symptomatic remission. Besides the clinical challenge of general prevention of puerperal psychosis the request of adequate models of inpatient treatment, carefully prepared discharge, close afterdischarge follow up, and continuous outpatient care have to be stressed.
Authors:
Hans-Peter Kapfhammer; Peter Lange
Publication Detail:
Type:  English Abstract; Journal Article    
Journal Detail:
Title:  Neuropsychiatrie : Klinik, Diagnostik, Therapie und Rehabilitation : Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater     Volume:  26     ISSN:  0948-6259     ISO Abbreviation:  Neuropsychiatr     Publication Date:  2012  
Date Detail:
Created Date:  2012-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9440588     Medline TA:  Neuropsychiatr     Country:  Germany    
Other Details:
Languages:  ger     Pagination:  129-38     Citation Subset:  IM    
Affiliation:
Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich, hans-peter.kapfhammer@klinikum-graz.at.
Vernacular Title:
Suizidale und infantizide Risiken im Wochenbett - klinische Erfahrungen bei Frauen mit Puerperalpsychose eines frühen Beginns.
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