Puerperal delirium

Introduction Postpartum status: Most of the onset is in the early postpartum period. In the early stages, there may be insomnia, irritability, emotional instability, loss of appetite, etc., and later develop into a worry about the newborn, irritability, suspicion, and then quickly appear obvious psychomotor excitement, confusion, accompanied by various hallucinations, I heard the baby crying and others talking about her. There is no danger of caring for newborns and there is also the danger of killing babies.

Cause

(1) Causes of the disease

The exact cause is still unclear, and many studies suggest that the related factors of the disease are related to the combined effects of physiological, psychological and social factors.

Biological factors

(1) Changes in hormone levels in postpartum are the biological basis for its occurrence. After delivery, the fetal placenta is delivered, and the levels of estrogen and progesterone in the blood drop rapidly, reaching the level of non-pregnancy within 1 week after delivery. This physiological feature coincides with the peak period of PPD. Recently, some scholars have achieved significant effects in the prevention and treatment of PPD with low-dose estrogen and progesterone, which will contribute to the in-depth study of its pathogenesis.

(2) Studies have shown that postpartum HCG levels are significantly decreased, prolactin levels are rising rapidly, hypothalamic-pituitary-adrenal axis function changes, and hypothyroidism are associated with postpartum PPD.

(3) Another study found that the reduction of serotonin, norepinephrine, and dopamine levels is associated with postpartum depression, which is associated with postpartum mania. It is believed that postpartum -endorphin decreases rapidly, and elevation of 2-adrenergic receptors is also associated with postpartum depression.

(4) The factors of childbirth: long labor time, birth control, midgut, cesarean section, postpartum hemorrhage, infection, lack of lactation or neonatal factors such as low birth weight, neonatal asphyxia, complications and mergers during pregnancy The incidence of postpartum depression is also increasing.

2. Psychological factors

The study found that women have psychological changes, emotional vulnerability, strong dependence and other changes during pregnancy and childbirth, so various stimuli during pregnancy and pregnancy may cause psychological abnormalities. In addition to the above factors, unplanned pregnancy, anxiety about childbirth, fear, the health of the baby, the gender of the baby, and the anxiety of becoming a mother to care for the child can cause psychological stress.

3. Social factors

Studies at home and abroad have shown that marriage breakdown or tension, separation of husband and wife, family disharmony, difficulties in life, lack of care of the husband and family and society, low level of education, and low perinatal health care services may be the cause of PPD.

(two) pathogenesis

According to the study, postpartum psychosis is related to family history of bipolar disorder, history of bipolar disorder, primipara, and poor support of husband. It indicates that the incidence of postpartum psychosis is related to genetic, psychosocial factors, personality defects, physical factors and hormonal changes accumulated after childbirth. Some people think that forced personality and immature personality women are prone to post-production mental illness. Wieck et al. (1991) proposed an endocrine mechanism that was found to be predictable to some extent by postpartum morphine thorn experiments. Postpartum dehydrated morphine experiments showed that women with increased hormone secretion were most likely to develop post-production psychosis. However, this experiment was not taken seriously by Meakin et al. (1995).

an examination

Related inspection

Brain nerve examination, brain CT examination, electroencephalography, cerebral angiography

The onset is mostly in the early postpartum period. In the early stages, there may be insomnia, irritability, emotional instability, loss of appetite, etc., and later develop into a worry about the newborn, irritability, suspicion, and then quickly appear obvious psychomotor excitement, confusion, accompanied by various hallucinations, I heard the baby crying and others talking about her.

Differential diagnosis

The most important feature of puerperal psychosis is the emergence of pathological thinking. According to the onset time and thinking characteristics, combined with the psychiatric scale can make a diagnosis and distinguish it from other puerperal mental disorders. Once the diagnosis of puerperal psychosis is made, it will have a great impact on the patient and his family. Therefore, the diagnosis should be extremely cautious. If necessary, consult a psychiatrist.

Postpartum depression usually occurs within 2 weeks after delivery, and the symptoms are obvious after 4 to 6 weeks of labor. The clinical manifestations are the same as those of postpartum depression syndrome, but to a more severe extent, even the tendency to commit suicide or infant injury. The Edinburgh Postpartum Depression Scale score with a total score of 13 can be diagnosed as postpartum depression; the diagnostic criteria for postpartum depression developed by the American Psychiatric Association (1994) in the Diagnostic and Statistical Manual of Mental Disorders can also be used. Progressive identification.

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