Editing Postpartum depression (section)

====Psychosis====
[[Postpartum psychosis]] is not a formal diagnosis, but is widely used to describe a [[Emergency psychiatry|psychiatric emergency]] that appears to occur in about 1 in 1000 pregnancies, in which symptoms of high mood and racing thoughts ([[mania]]), depression, severe confusion, loss of inhibition, paranoia, hallucinations, and delusions begin suddenly in the first two weeks after delivery; the symptoms vary and can change quickly.<ref name="LancetRev2014">{{cite journal | vauthors = Jones I, Chandra PS, Dazzan P, Howard LM | title = Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period | journal = Lancet | volume = 384 | issue = 9956 | pages = 1789–1799 | date = November 2014 | pmid = 25455249 | doi = 10.1016/s0140-6736(14)61278-2 | s2cid = 44481055 }}</ref> It is different from postpartum depression and [[maternity blues]].<ref name="RoyColl2014">{{cite web|title=Postpartum Psychosis|url=http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/postpartumpsychosis.aspx|publisher=Royal College of Psychiatrists|access-date=27 October 2016|date=2014|url-status=live|archive-url=https://web.archive.org/web/20161024152200/http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/postpartumpsychosis.aspx|archive-date=24 October 2016}}</ref> It may be a form of [[bipolar disorder]].<ref name="WesselooRev2016">{{cite journal | vauthors = Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V | title = Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis | journal = The American Journal of Psychiatry | volume = 173 | issue = 2 | pages = 117–127 | date = February 2016 | pmid = 26514657 | doi = 10.1176/appi.ajp.2015.15010124 | doi-access = free }}</ref> It is important not to confuse psychosis with other symptoms that may occur after delivery, such as delirium. Delirium typically includes a loss of awareness or inability to pay attention.<ref name="DSM5" />

About half of women who experience postpartum psychosis have no risk factors; but a prior history of mental illness, especially bipolar disorder, a history of prior episodes of postpartum psychosis, or a family history put some at a higher risk.<ref name=LancetRev2014/>

Postpartum psychosis often requires hospitalization, where treatment is [[antipsychotic]] medications, [[mood stabilizer]]s, and in cases of strong risk for suicide, [[electroconvulsive therapy]].<ref name=LancetRev2014/>

The most severe symptoms last from 2 to 12 weeks, and recovery takes 6 months to a year.<ref name=LancetRev2014/> Women who have been hospitalized for a psychiatric condition immediately after delivery are at a much higher risk of suicide during the first year after delivery.<ref name="OrsoliniRev2016">{{cite journal | vauthors = Orsolini L, Valchera A, Vecchiotti R, Tomasetti C, Iasevoli F, Fornaro M, De Berardis D, Perna G, Pompili M, Bellantuono C | title = Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates | journal = Frontiers in Psychiatry | volume = 7 | page = 138 | date = 12 August 2016 | pmid = 27570512 | pmc = 4981602 | doi = 10.3389/fpsyt.2016.00138 | doi-access = free }}</ref>

'''Childbirth-Related/Postpartum Posttraumatic Stress Disorder'''

Parents may suffer from post-traumatic stress disorder (PTSD), or suffer post-traumatic stress disorder symptoms, following childbirth.<ref name="Yildiz-2017">{{cite journal | vauthors = Yildiz PD, Ayers S, Phillips L | title = The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis | journal = Journal of Affective Disorders | volume = 208 | pages = 634–645 | date = January 2017 | pmid = 27865585 | doi = 10.1016/j.jad.2016.10.009 | url = https://eprints.worc.ac.uk/11415/1/s13063-021-05545-6.pdf }}</ref> While there has been debate in the medical community as to whether childbirth should be considered a traumatic event, the current consensus is childbirth can be a traumatic event.<ref name="Heyne-2022">{{cite journal | vauthors = Heyne CS, Kazmierczak M, Souday R, Horesh D, Lambregtse-van den Berg M, Weigl T, Horsch A, Oosterman M, Dikmen-Yildiz P, Garthus-Niegel S | title = Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis | journal = Clinical Psychology Review | volume = 94 | page = 102157 | date = June 2022 | pmid = 35584590 | doi = 10.1016/j.cpr.2022.102157 | hdl-access = free | s2cid = 248337797 | hdl = 1871.1/4788a1a5-deff-427f-bd77-a33ebdaf22fc | url = https://research.vu.nl/en/publications/4788a1a5-deff-427f-bd77-a33ebdaf22fc }}</ref> The DSM-IV and DSM-5 (standard classifications of mental disorders used by medical professionals) do not explicitly recognize childbirth-related PTSD, but both allow childbirth to be considered as a potential cause of PTSD.<ref name="Heyne-2022"/> Childbirth-related PTSD is closely related to postpartum depression. Research indicates mothers who have childbirth-related PTSD also commonly have postpartum depression.<ref name="Yildiz-2017"/><ref name="Dekel-2017">{{cite journal | vauthors = Dekel S, Stuebe C, Dishy G | title = Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors | journal = Frontiers in Psychology | volume = 8 | page = 560 | date = 2017 | pmid = 28443054 | pmc = 5387093 | doi = 10.3389/fpsyg.2017.00560 | doi-access = free }}</ref> Childbirth-related PTSD and postpartum depression have some common symptoms. Although both diagnoses overlap in their signs and symptoms, some symptoms specific to postpartum PTSD include being easily startled, recurring nightmares and flashbacks, avoiding the baby or anything that reminds one of birth, aggression, irritability, and panic attacks.<ref name="Ayers-2018">{{cite journal | vauthors = Ayers S, Wright DB, Thornton A | title = Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale | journal = Frontiers in Psychiatry | volume = 9 | page = 409 | date = 2018-09-18 | pmid = 30279664 | pmc = 6153962 | doi = 10.3389/fpsyt.2018.00409 | doi-access = free }}</ref> Real or perceived trauma before, during, or after childbirth is a crucial element in diagnosing childbirth-related PTSD.<ref>{{cite journal | vauthors = Grekin R, O'Hara MW | title = Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis | journal = Clinical Psychology Review | volume = 34 | issue = 5 | pages = 389–401 | date = July 2014 | pmid = 24952134 | doi = 10.1016/j.cpr.2014.05.003 }}</ref>

Currently, there are no widely recognized assessments that measure postpartum post-traumatic stress disorder in medical settings. Existing PTSD assessments (such as the DSM-IV) have been used to measure childbirth-related PTSD.<ref name="Yildiz-2017"/> Some surveys exist to measure childbirth-related PTSD specifically, however, these are not widely used outside of research settings.<ref name="Ayers-2018"/>

Approximately 3-6% of mothers in the postpartum period have childbirth-related PTSD.<ref name="Yildiz-2017"/><ref name="Heyne-2022"/><ref name="Van Sieleghem-2022">{{cite journal | vauthors = Van Sieleghem S, Danckaerts M, Rieken R, Okkerse JM, de Jonge E, Bramer WM, Lambregtse-van den Berg MP | title = Childbirth related PTSD and its association with infant outcome: A systematic review | journal = Early Human Development | volume = 174 | page = 105667 | date = November 2022 | pmid = 36152399 | doi = 10.1016/j.earlhumdev.2022.105667 | s2cid = 252342586 }}</ref><ref name="Cook-2018">{{cite journal | vauthors = Cook N, Ayers S, Horsch A | title = Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review | journal = Journal of Affective Disorders | volume = 225 | pages = 18–31 | date = January 2018 | pmid = 28777972 | doi = 10.1016/j.jad.2017.07.045 | s2cid = 5007700 | doi-access = free }}</ref> The percentage of individuals with childbirth-related PTSD is approximately 15-18% in high-risk samples (women who experience severe birth complications, have a history of sexual/physical violence, or have other risk factors).<ref name="Yildiz-2017" /><ref name="Cook-2018"/> Research has identified several factors that increase the chance of developing childbirth-related PTSD. These include a negative subjective experience of childbirth, maternal mental health (prenatal depression, perinatal anxiety, acute postpartum depression, and history of psychological problems), history of trauma, complications with delivery and baby (for example emergency cesarean section or NICU admittance), and a low level of social support.<ref name="Dekel-2017"/><ref>{{cite journal | vauthors = Lai X, Chen J, Li H, Zhou L, Huang Q, Liao Y, Krewski D, Wen SW, Zhang L, Xie RH | title = The incidence of post-traumatic stress disorder following traumatic childbirth: A systematic review and meta-analysis | journal = International Journal of Gynaecology and Obstetrics | volume = 162 | issue = 1 | pages = 211–221 | date = July 2023 | pmid = 36571476 | doi = 10.1002/ijgo.14643 | s2cid = 255181351 }}</ref>

Childbirth-related PTSD has several negative health effects. Research suggests that childbirth-related PTSD may negatively affect the emotional attachment between mother and child.<ref name="Van Sieleghem-2022"/> However, maternal depression or other factors may also explain this negative effect.<ref name="Van Sieleghem-2022" /> Childbirth-related PTSD in the postpartum period may also lead to issues with the child's social-emotional development.<ref name="Van Sieleghem-2022" /> Current research suggests childbirth-related PTSD results in lower breastfeeding rates and may prevent parents from breastfeeding for the desired amount of time.<ref name="Cook-2018"/>