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TRANSCRIPT
A Trauma-‐Informed Understanding of
Postpartum Psychosis in Forensic Settings
Diana Lynn Barnes, Psy.D
The Center for Postpartum Health
A trauma-‐informed understanding of
postpartum psychosis in forensic settings
THERE ARE NO FINANCIAL DISCLOSURES
OBJECTIVES
1. identify 5 symptoms of postpartum psychosis
2. describe the connection between complex trauma and mental illness
3. list 3 risk factors for postpartum psychosis
4. explain how the legal definition of insanity creates difficulty in the courtroom
5. name 3 types of pregnancy denial
What is Postpartum Psychosis
� Mania
� Thought disorder � Cognitive confusion � Delusions � hallucinations � Sleep disturbance � Amnesia
� Agitation � Severe mood fluctuations
� Depersonalization � Dissociation � Waxing and waning
risk factors for postpartum psychosis
v Personal/family hx of bipolar disorder, schizophrenia, schizoaffective disorder, major depressive disorder with psychotic features
v Complex trauma in childhood
v Death of one’s mother when < 5 yrs old (suicide)
risk factors for pregnancy denial
� < age 25 � Women of minority
� Childhood trauma
� Family hx of substance abuse
� dependent on family for economic survival
� Poor problem solving skills
characteristics of pervasive pregnancy denial
� Pregnancy related symptoms are misinterpreted
� Onset of labor is not recognized � Babies almost always born in the bathroom � Dissociation during labor � Families collude with the denial
“Iatrogenic participation”
WHAT DOES THE DSM
HAVE TO DO WITH IT?
The DSM V has No diagnosis for postpartum psychosis No diagnosis for pregnancy denial
The Neurobiology of Trauma
HPA Axis over-‐reactivity and dysregulation Elevations in cortisol preceding psychosis onset Reduced gray matter in the frontal lobe Changes in the hippocampus
Read, J., Bentall, R. P., & Fosse, R. (2009). Time to abandon the bio-‐bio-‐bio model of psychosis: exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiologia e psichiatria sociale, 18(04), 299-‐310
traumatic information is
stored
Ø CORTEX – cognitive memory
Ø LIMBIC – emotional memory
Ø MIDBRAIN/CEREBELLUM – vestibular memory
Ø BRAINSTEM – state memory
differential responses to
threat
Sympathetic N.S.
� Reactive � Hypervigilant � Scanning the environment
� >heart rate, blood pressure � Alarm response
� Anxious � Flight � Panic, impulsivity
Parasympathetic N.S.
� Detachment
� Numbing
� Dissociation � Derealization � Compliant
� Suspension in time
� Atypical psychotic reaction
Adverse Childhood Experiences
Study
disrupted neurodevelopment social emotional and cognitive impairment
adoption of health risk behaviors
disease, emotional disturbances
early mortality
Anda, R.F., Felitti, V.J. & Bremer, D.J. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(4).256-‐263
what is a delusion?
A fixed and rigid belief that cannot be willed away despite any rational evidence
to the contrary.
In the courtroom -‐
mistaken ideas about
postpartum psychosis
� Mothers with postpartum psychosis are “bad” mothers
� If you have postpartum psychosis, you intended to kill your child (premeditation)
� You can tell a woman has postpartum psychosis just by looking at her
� A woman with postpartum psychosis is a danger to society
� Once psychotic, always psychotic
In the courtroom – what to teach
about postpartum psychosis
� postpartum psychosis is the perpetrator
� The mother is also a victim
� Postpartum psychosis by its very nature renders a woman insane
� In the midst of a postpartum psychotic episode, there is an absence of psychological thought making it impossible to determine right from wrong.
� Delusions cannot be willed away or confronted
� Hearing voices is not a confirmation of premeditation
� Infanticide is frequently altruistic
REFERENCES
� Barnes, D.L. ed. (2014). Women’s reproductive mental health across the lifespan. New York: Springer Publishing
� Meyer, C.L. & Oberman, M. (2001). Mothers who kill their children: Understanding the acts of moms from Susan Smith to the “prom mom”. New York: New York University Press.
� Moskowitz, A. Schäfer, I. & Dorahy, M.J. (2008). Psychosis, trauma & dissociation: Emerging perspectives on severe psychopathology. Oxford: Wiley-‐Blackwell
� Spinelli, M.G. ed. (2003). Infanticide: Psychosocial & legal perspectives on mothers who kill. Washington, D.C.: American Psychiatric Publishing.