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.g.pain, digestive problems, headaches);(18) Skills for functioning in social situations, work settings, or school have significantlydecreased;(19) Thoughts of hopelessness or pessimism;(20) Thoughts of death, suicide, or homicide.POSTPARTUM PSYCHOSISA small number of mothers experiencing postpartum depression will continue adownward course and spiral into an episode of postpartum psychosis.This occurs inapproximately 1 per 1000 births8.Disordered thinking, loss of reality, reduced ability forabstract thinking, and increased negative symptoms may be more prominent than obvioushallucinations and delusions.Patients who have a history of bipolar disorder can moveinto psychosis from either a depressive or a manic episode.In the midst of a psychoticepisode the person s altered reality can override solidly developed moral codes and usherin tragic behaviors that leave scarred memories throughout the family and even thecommunity.The following is an example of how untreated postpartum depressionevolved into postpartum psychosis, and in the shortest of time resulted in an unpredictedand unthinkable tragedy.THE STORY OF MINE*She was brilliant, on the very edge of making a mark in academia, until postpartumdepression ushered in pain, confusion, and the horror of two unexpected deaths.Minewas fluent in English, French, Turkish, and several Arabic dialects.Both before and afterreceiving her doctorate, Mine traveled throughout the Middle East and Europedeveloping research studies and speaking in the defense of the poorest of the poor.InCairo and Istanbul her efforts helped to increase awareness of government-sponsoredassistance for the destitute.With knowledge and compassion, Mine had the ability tochange how people and governments understood the responsibility, purpose, and role of Suicide and bipolar disorders 75charity.Colleagues credit Mine as one of those rare individuals who could comprehendall of the dimensions of an issue, and yet embrace criticism.Her energy and dedicationseemed boundless.Mine s final book, Managing Egypt s Poor and the Politics ofBenevolence, 1800 1952, published by Princeton University Press in 2003, used policeand other historical records to interpret the historical interplay between philanthropy,politics, and the poor.She was determined to create change and promote social justice bygiving a voice and history to forgotten beggars, and families drowning in, yet survivingin, hopeless poverty (Figure 5.3).As Mine turned 38 years old, she was a successful academic, happily married, in goodhealth with no history of mental illness, excited about being pregnant, and eternallyoptimistic.She was contagiously happy, and people gravitated to her.Sadly, in the fall of2003, shortly after the birth of a child with Down s syndrome, Mine was swallowed upby the overwhelming despair of postpartum depression.Figure 5.3 Mine before the onset ofpostpartum depression and psychosis.She was energetic, happy, andsuccessfulFrom joy to depression and psychosisThe news that her baby, named Raya, had Down s syndrome was met with determination,acceptance, and appropriate concern.True to her nature, Mine dove into books on caringfor a Down s syndrome baby, organizing notes, developing resource files, and case-managing a host of specialist and community agencies.Not atypical for Down ssyndrome babies, Raya was unable to develop a strong enough sucking response forbreast- or bottle-feeding.To resolve the problem, a nasal/gastric feeding tube wasinserted.This added work and difficulty for Mine and her husband, but did not deter theiroptimism, energy, and parental dedication.For the first 4 months, Mine was a determinedmother providing emotional and physical care.Family members marveled at howsmoothly she managed the added work created by the feeding tube and other care Atlas of bipolar disorders 76requirements.In these early months, Mine was forever holding, rocking, and talking toRaya (Figure 5.4).The baby s smile delighted both Mine and her husband.In addition, she told friendsand family that Raya slept well, seldom fussed, and was amazingly accommodating.Thefamily saw a woman successfully balancing a spousal relationship, professionalobligations, and motherhood.During a visit to her family in Saint Paul, Minnesota, hints of a problem and change inMine became apparent for the first time as the baby*The author wishes to thank Mine s family for sharing this important story and allowing it to bepublished.Figure 5.4 Mine and Raya, June 2003.A relaxed Mine and baby withoutobvious signs of postpartumdepression.People can often hidesymptoms, continue with life, andpretend that things will get better whendepression first startsturned 5 months old.She became quieter, needed more rest, and expressed concerns forthe baby.Mine was also starting to express worries that the baby was not eating enoughand would have to continue using a feeding tube.The family recalls that while it wouldbe unfair to say that she obsessed about the child s nutrition, it clearly had become afocus of her attention and a repeated theme.Yet, in the eyes of friends and family, Minecontinued to appear happy, calm, and in control of herself and the baby.Pictures takenduring this period show a mother and baby spontaneously smiling at each other.Onemonth later Mine cut short a vacation, and went to her mother s house in Saint Paul,where she had grown up. Suicide and bipolar disorders 77Upon arrival she was visibly depressed, upset, and physically stressed.Mine s voicewas weak, her body held in an uncomfortable tense posture.Sorrow and despair werereflected in her face.Most of the coping skills she was known for were gone.In adefeated tone, Mine told how she could no longer care for Raya, that it was too difficult.The family rallied around her, and intuitively knew not to leave Mine alone.Within days,as the list of symptoms increased, the family grew painfully aware that professional helpwas needed.Sadness, anger, and anxiety filled Mine s face most of each day.Feeding thebaby had become an odious and difficult task.When nursing, Mine held her upper bodyin a tense fashion and anxiously pushed up on the balls of her feet.She was obsessed withthe idea that her breast-milk lacked any nutrition [ Pobierz całość w formacie PDF ]
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.g.pain, digestive problems, headaches);(18) Skills for functioning in social situations, work settings, or school have significantlydecreased;(19) Thoughts of hopelessness or pessimism;(20) Thoughts of death, suicide, or homicide.POSTPARTUM PSYCHOSISA small number of mothers experiencing postpartum depression will continue adownward course and spiral into an episode of postpartum psychosis.This occurs inapproximately 1 per 1000 births8.Disordered thinking, loss of reality, reduced ability forabstract thinking, and increased negative symptoms may be more prominent than obvioushallucinations and delusions.Patients who have a history of bipolar disorder can moveinto psychosis from either a depressive or a manic episode.In the midst of a psychoticepisode the person s altered reality can override solidly developed moral codes and usherin tragic behaviors that leave scarred memories throughout the family and even thecommunity.The following is an example of how untreated postpartum depressionevolved into postpartum psychosis, and in the shortest of time resulted in an unpredictedand unthinkable tragedy.THE STORY OF MINE*She was brilliant, on the very edge of making a mark in academia, until postpartumdepression ushered in pain, confusion, and the horror of two unexpected deaths.Minewas fluent in English, French, Turkish, and several Arabic dialects.Both before and afterreceiving her doctorate, Mine traveled throughout the Middle East and Europedeveloping research studies and speaking in the defense of the poorest of the poor.InCairo and Istanbul her efforts helped to increase awareness of government-sponsoredassistance for the destitute.With knowledge and compassion, Mine had the ability tochange how people and governments understood the responsibility, purpose, and role of Suicide and bipolar disorders 75charity.Colleagues credit Mine as one of those rare individuals who could comprehendall of the dimensions of an issue, and yet embrace criticism.Her energy and dedicationseemed boundless.Mine s final book, Managing Egypt s Poor and the Politics ofBenevolence, 1800 1952, published by Princeton University Press in 2003, used policeand other historical records to interpret the historical interplay between philanthropy,politics, and the poor.She was determined to create change and promote social justice bygiving a voice and history to forgotten beggars, and families drowning in, yet survivingin, hopeless poverty (Figure 5.3).As Mine turned 38 years old, she was a successful academic, happily married, in goodhealth with no history of mental illness, excited about being pregnant, and eternallyoptimistic.She was contagiously happy, and people gravitated to her.Sadly, in the fall of2003, shortly after the birth of a child with Down s syndrome, Mine was swallowed upby the overwhelming despair of postpartum depression.Figure 5.3 Mine before the onset ofpostpartum depression and psychosis.She was energetic, happy, andsuccessfulFrom joy to depression and psychosisThe news that her baby, named Raya, had Down s syndrome was met with determination,acceptance, and appropriate concern.True to her nature, Mine dove into books on caringfor a Down s syndrome baby, organizing notes, developing resource files, and case-managing a host of specialist and community agencies.Not atypical for Down ssyndrome babies, Raya was unable to develop a strong enough sucking response forbreast- or bottle-feeding.To resolve the problem, a nasal/gastric feeding tube wasinserted.This added work and difficulty for Mine and her husband, but did not deter theiroptimism, energy, and parental dedication.For the first 4 months, Mine was a determinedmother providing emotional and physical care.Family members marveled at howsmoothly she managed the added work created by the feeding tube and other care Atlas of bipolar disorders 76requirements.In these early months, Mine was forever holding, rocking, and talking toRaya (Figure 5.4).The baby s smile delighted both Mine and her husband.In addition, she told friendsand family that Raya slept well, seldom fussed, and was amazingly accommodating.Thefamily saw a woman successfully balancing a spousal relationship, professionalobligations, and motherhood.During a visit to her family in Saint Paul, Minnesota, hints of a problem and change inMine became apparent for the first time as the baby*The author wishes to thank Mine s family for sharing this important story and allowing it to bepublished.Figure 5.4 Mine and Raya, June 2003.A relaxed Mine and baby withoutobvious signs of postpartumdepression.People can often hidesymptoms, continue with life, andpretend that things will get better whendepression first startsturned 5 months old.She became quieter, needed more rest, and expressed concerns forthe baby.Mine was also starting to express worries that the baby was not eating enoughand would have to continue using a feeding tube.The family recalls that while it wouldbe unfair to say that she obsessed about the child s nutrition, it clearly had become afocus of her attention and a repeated theme.Yet, in the eyes of friends and family, Minecontinued to appear happy, calm, and in control of herself and the baby.Pictures takenduring this period show a mother and baby spontaneously smiling at each other.Onemonth later Mine cut short a vacation, and went to her mother s house in Saint Paul,where she had grown up. Suicide and bipolar disorders 77Upon arrival she was visibly depressed, upset, and physically stressed.Mine s voicewas weak, her body held in an uncomfortable tense posture.Sorrow and despair werereflected in her face.Most of the coping skills she was known for were gone.In adefeated tone, Mine told how she could no longer care for Raya, that it was too difficult.The family rallied around her, and intuitively knew not to leave Mine alone.Within days,as the list of symptoms increased, the family grew painfully aware that professional helpwas needed.Sadness, anger, and anxiety filled Mine s face most of each day.Feeding thebaby had become an odious and difficult task.When nursing, Mine held her upper bodyin a tense fashion and anxiously pushed up on the balls of her feet.She was obsessed withthe idea that her breast-milk lacked any nutrition [ Pobierz całość w formacie PDF ]