Incidence and Nature of Puerperal Psychiatric Illness

Abstract

EMPHYSEMA BIUTISH~~~~~~~~~~~~~~~~~~~~~~~~~~~~M EDICALJ OURNALMeasures to control infection and relieve bronchospasm are the essentials of treatment. The value and dangers of oxygen therapy are pointed out and the lethal effect of morphine is stressed. REFERENCES Aslett, E. A., Hart, P. d'A., and McMichael, J. (1939). Proc. roy. Soc. B, 126, 502. Baldwin, E. de F., Cournand. A., and Richards, D. W. (1948). MedIcile. 27, 243. (1949). Ibid., 28, 201. Bloomfield, R. A., Lauson, H. D., Cournand, A., Breed, E. S.. and Richards, D. W. (1946). J. clin. Invest., 25, 639. Brock, R. C. (1948. Thorax, 3, 88. Christie, R. V. (1934). J. din. Invest., 13, 295. -(1939). Edinb. med. J., 46, 463. -(1944a). British Medical Journal, 1, 105. -(1944b). Ibid., 1, 143. -and McIntosh, C. A. (1934) Many writers have expressed the view that no form of psychiatric illness occurring in pregnancy or the puerperium is a specific clinical entity. The general opinion seems to be that the ordinary stress and strains of pregnancy, operating in predisposed individuals, produce non-specific mental illnesses which are indistinguishable from other mental reactions and are due to the interaction of factors-the pregnancy being of psychological importance only. Brew and Seidenberg (1950) state that these disorders occur only in predisposed individuals, and disregard the possibility that a physiological or endocrine disturbance may be the primary activating factor.As other surveys have been made only on patien.s who have been admitted to mental hospitals these conclusions are not justified; and as no psychiatric survey of women confined in maternity hospitals has been undertaken there is no evidence about the importance of alleged psychogenic factors.The question has been considered afresh by studying the case records of all the women delivered at maternity hospitals in Bristol between January, 1938, and June, 1948, a period of 104 years, the cases numbering about 37,000. Physical and psychological factors were noted in order to ascertain their importance. The incidence, nature, and outcome of mental reactions were studied, and all cases of mental illness related to the puerperium or pregnancy that were treated in Bristol Mental Hospitals during the same period were examined by me, thus there was a double check and control. The tables relate to these surveys. Reference has also been made to some other cases, which were not included in the surveys as they occurred in other years or outside Bristol.

Puerperal depression and excessive compliance with the mother

“…The patients were seen at University College Hospital and also at the Cassel Hospital where mothers with a psychiatric illness are admitted with their children (Main, 1958). This clinical experience supported Hemphill's finding that there is a clear-cut clinical entity of puerperal depression, distinct from manic-depressive psychosis (Hemphill, 1952), and the work of other writers (Brew & Seidenberg, 1950; Boyd, 1942) who suggest that the patients have a characteristic type of personality. This paper is largely concerned with this type of personality, and aspects of it which lead to the breakdown, particularly that which grows out of the early relationship between the patient and her mother.…”

Mother and baby unit: psychiatric survey of 115 cases.

“…Excluding deaths occurring during a 12-year follow-up, his mortality was 5.9%. Hemphill (1952) found five (4.3%) deaths in 116 cases of puerperal mental illness admitted to Bristol mental hospitals between January 1938 and June 1948-one was due to suicide and four were due to toxic delirium. C. Protheroe (personal communication, 1968) had no deaths in a series of 67 mothers admitted with their babies since 1964 to St. Nicholas Hospital, Newcastle upon Tyne.…”

Puerperal Mental Illness

“…There was Previous Mental Illness.-In 17 patients (22.6%) there was ses the convula past history of mental illness. The corresponding figure one and suxa-given by Hemphill (1952) was 13% and by Foundeur et al…”

“…In addition, there is a well-marked affective element, usually depressive with ideas of guilt, but sometimes maniacal. This corresponds to a group called " mixed schizophrenia " by Hemphill (1952 …”

“…Not one of 75 patients has become a chronic hospital invalid. It has been stated that electroplexy should be avoided for one month after confinement because of the danger of embolism from the pelvic veins during the convulsion (Jacobs, 1943;Feldman et al, 1946;Brew and Seidenberg, 1950;Hemphill, 1952). Feldman et al reported a death eight hours after an E.C.T.…”