Severe postpartum depression. Manifestations of severe postpartum depression

Posted onOctober 26, 2019

Patient O., 23 years old, working. She entered the psychiatric ward of the Botkin Hospital on 28 / VII 1962. My father suffers from chronic alcoholism. Childhood passed in difficult conditions. Grew normally. She graduated only 5 classes, studied mediocre. By nature, soft, good-natured, sociable. Menses from 15 years. Pregnancy and childbirth first. Pregnancy proceeded easily 14 / VII 1962. normal birth. The child (boy) was very happy. The first days after the birth I felt satisfactory, but I did not sleep well. On the 8th day after the birth, the mood decreased, my throat ached, and the temperature was 37.8 °. At home, she tried to do household work, but “everything fell out of her hands”. She asked her husband for forgiveness, called herself a sinner, and said that she had “lived with other men” before her marriage, although this was not true. Tried to hang herself. Upon admission to the psychiatric ward there is a pronounced strangulation groove on the neck. The physique of the patient is closer to the picnic. The pharynx is slightly hyperemic. Temperature 37.2 °. Heart sounds are clear. Blood pressure 120/80 mm RT. Art. The pulse is 98 beats per minute, rhythmic. Vesicular respiration in the lungs According to the conclusion of the gynecologist, the condition of the genital organs corresponds to the normal course of the postpartum period. Blood test: HB 13.4 g%, l. 8200, e. 1%, p. 4%, s. 65%, lymph. 21% mon 9%; ROE 27 mm per hour. Traces of protein were found in the analysis of urine, a small number of white blood cells. The patient is extremely stressed, asks if the child is alive, believes that he is already dead. It is not oriented in time, “everything is dead all around”; “I don’t understand where I am.” She said that she “wanted to strangle her, because because of me all the dead”, “around the dead.” Expresses the expressed delirium of guilt and sinfulness: “I am dirty, worthless, killed a child”, “Strangled my soul and child.” It pinches itself and declares that it does not feel. However, according to relatives, it did not show aggression to the newborn. Stubbornly insists that he will hang himself anyway, “they will be taken to all the shops of the factory for the murder of a child as a sinner,” where the patient worked. He hears dogs barking, “voices” predict her inevitable death and “eternal torment”. She sat in the department, frozen in one position, on her face an expression of deep sorrow. It is difficult to feed, taking medications irregularly. At times, with the influx of “condemning voices,” it begins to rush about, asking to bring “at least a dead child, whom I have destroyed.” Refuses to go to bed, lying on the floor. This condition lasted for a week. The patient received parenteral aminazine 200 mg per day, melipramine 100 mg orally. From 2 / VIII, improvement began, it became calmer, slept, there was no longing, the “voices” stopped. The final recovery came only by 19 / VIII, before that the condition was unstable, periodically there were short episodes of dreary mood. According to the medical history, over the next years he is practically healthy, he is raising a child, working, fulfilling the production plan by 120-140%. Relations with her husband are good. Complaints about the state of health does not express. In this case, any analogies with the reactive state can be immediately refuted. Mild sore throat began in the patient already after the occurrence of insomnia and mood disturbance. After a several days initial period of insomnia and a dreary mood, ideas of self-accusation and sinfulness, suicidal tendencies appeared. Upon admission to the hospital, the patient had a stage of more severe disintegration of his mental life, accompanied by derealization (“everything died around”) and depersonalization. The abundance of hallucinations also indicated a certain violation of consciousness. In time, the patient was disoriented. A condition close to a depressive stupor alternated with agitation, and statements with “eternal torment” and immortality resembled Kotar syndrome. The course of psychosis was undulating in nature, which also indicated the predominance of diencephalic disorders. Despite the polymorphism of symptoms, depression remained the leading and most constant syndrome. Sometimes the wave-like flow createdthe impression that all psychosis consists of several separate phases. The main background, the most persistent and persistent syndrome was depression, accompanied by typical feelings of inferiority. Weighting, generalization of psychosis led to the appearance of depersonalization, accompanied by an already more pronounced violation of consciousness. Further deepening and generalization of the pathological process caused a picture of oneiric catatonia. In the presence of somatic disorders, onyroid symptoms passed into the picture of catatonic amentia, however, it cannot be ruled out that the fever was due to diencephalic disorders. Thus, the unity of psychopathological symptoms was clearly expressed; All features and dynamics from depression to amentia depended on the degree and depth of disintegration of the central nervous system. This indicates that postpartum depression is not a special, isolated form of the “group” of postpartum psychoses, but is only one option for a single postpartum psychosis. Not only for depression, but also for other variants of postpartum psychoses, the delusional themes of “guilt”, alienation, and hostility to the child and husband are characteristic. Along with a feeling of hostility to the husband, patients often express ideas of jealousy, sometimes reaching the point of delirium. The cessation of psychosis also went through a phase of depression, which was the main background of psychosis, in which, under the influence of the deepening of the disease state, other disorders that were different from depression, but closely related to it, arose.

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