Academic journal article The Qualitative Report

Comprehensive Treatment of Women with Postpartum Psychosis across Health Care Systems from Swedish Psychiatrists' Perspectives

Academic journal article The Qualitative Report

Comprehensive Treatment of Women with Postpartum Psychosis across Health Care Systems from Swedish Psychiatrists' Perspectives

Article excerpt

The puerperium has been associated with an increased risk of developing psychiatric disorders with the most serious being psychosis (Brockington, 2004; Kendell, Chalmers, & Platz, 1987; Terp & Mortensen, 1998; WHO, 1992). The focus of this study is to explore psychiatrists' experiences treating women with postpartum psychosis (PPP).

Psychiatrists who treat women with PPP face a number of challenges as they determine the best treatment in a given situation. Since PPP is a rare condition, most psychiatrists do not regularly treat this high risk population, they must balance between respecting their own decisions and consultations they obtain from colleagues in trying to determine the best plan of care (Seeman, 2004). One must believe this is a situation that is challenging for the psychiatrists who care for and treat a woman with PPP. Therefore the research question, how do psychiatrists experience providing care and treatment for women with PPP, is explored in this study.

It has been estimated that one to two in 1,000 newly delivered mothers will need hospitalization for PPP (Kendell et al., 1987; Noorlander, Bergink, & van den Berg, 2008; Terp & Mortensen, 1998). Postpartum psychosis is a very serious illness with a 4% risk of infanticide and 5% risk for suicide (Comtois, Schiff, & Grossman, 2008; Knops, 1993). The onset of PPP occurs within four weeks after delivery (APA, 2000) and usually begins with one or two sleepless nights. The woman may experience tearfulness, confusion, suspiciousness, and obsessions. Often the woman denies the birth, has delusions about the baby and/or thoughts of killing her baby (Friedman, Sorrentino, Stankowski, Holden, & Resnick, 2008; Heron, McGuiness, Robertson Blackmore, Craddock, & Jones, 2008; Koenen & Thompson, 2008). These acute symptoms warrant hospitalization on a psychiatric unit and close observation. Early detection, treatment, and intervention are crucial. Treatment should consist of antipsychotics, anxiolytics, and/or Electro Convulsive Therapy (ECT) depending on the clinical presentation (Boritz Wintz, 1999; Forray & Ostroff, 2007; Menon, 2008; Sharma, 2008). Although Lithium treatment is usually considered incompatible with breastfeeding, recent research has provided evidence to the contrary (Moretti, Koren, Verjee, & Ito, 2003; Viguera, Newport, Ritchie, Stowe, Whitfield, Mogielnicki, et al., 2007). Postpartum psychosis has a favorable prognosis with most women recovering in two to six weeks. However, some women will develop a psychiatric illness for a long period of time (Robertson Blackmore, Craddock, Walters, & Jones, 2008).

When a woman refuses hospitalization, involuntary commitment is often necessary due to the severity of the illness. Involuntary commitment of psychiatric patients is accepted worldwide as a needed measure in order to treat very ill psychotic patients who resist treatment. The Law of Compulsory Psychiatric Care Act in Sweden (The act, 1991:1128/2008:415) provides for compulsory care but only if the patient is suffering from a severe mental disorder and if the person's mental status requires psychiatric treatment which can not be met in a least restrictive environment. Patients who require involuntary commitment must be a danger to themselves or others. A patient who is detained under this Act may be strapped for a short-period of time with a belt or similar device, and/or isolated from other patients. Treatment should be provided in cooperation with the patient and family as much as is possible (The act, 1991:1128/2008:415).

Psychiatrists are experts and acquire their expert position through knowledge, clinical practice, personal skills and technical information (Razzouk, Mari, Shirakawa, Wainer, & Sigulem, 2006). According to Norman (2005) an expert has superior knowledge, formal and informal that is used in determining the solution to a particular problem as well as the ability to organize knowledge. …

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