Epidemiological, clinical and ethnological particularities of puerperal psychosis in Toamasina, Madagascar

Introduction: A descriptive retrospective study in the Psychiatry service of the Analankininina University Hospital Center of Toamasina Madagascar was conducted from January 1st to December 31st, 2018 to know the epidemiological, clinical and ethnological particularities of puerperal psychosis affecting women hospitalized in this service. Methodology and results: Women presenting mental disorders corresponding to the diagnostic of puerperal psychosis coded F.53 from the Tenth version of the International Classification of Diseases of the WHO were included. Then, among the 451 patients hospitalized at the Toamasina Psychiatry Service, 27 women presented puerperal psychosis. The average age was 25 years with extreme ages of 18 and 34 years. The age between 20 to 24 years was the most affected. According to the level of education, 55.55% of patients attended secondary school and 29.62% had a school break in primary level. They were housewives in 51.85% of cases, married in 59.25%. Obstetrically, 59.25% of patients are primiparous, delivered vaginally in 92.59% and by caesarean surgery in 7.40 % of cases. They had full-term births in 92.59% of cases and premature births in 7.40%. Psychiatrically, no family past of mental troubles was reported in 88.88% of the patients while 7.40 % have had it with first-degree relatives. Furthermore, no personal history of psychosis was found in 74.07% of the patients, while 22.22% had a history of psychosis and 3.70% a history of bipolar disorders. A traumatic experience of childbirth was reported in 22.22% of patients, while 18.51% reported traumatic previous pregnancies and/or deliveries. Marital conflicts (14.81%) and financial difficulties (11, 11%) were the most present stressors. Clinically, puerperal psychosis appeared on average within 8 to 14 days postpartum in 37% of cases. The most presented clinical signs were insomnia (81.48%), delusional state (59.25%), behavioral dissociation (51.85%), anorexia and weight loss (44. 44%) and psychomotor agitation (37.03%). Polymorphic thema of delusions were the most observed in 44.44% of cases. Brief delusional psychoses were the most reported (51.85%), followed by depressive states (25.92%) and schizophrenic troubles (14.81%). Conclusion: Psychological preparation and support for women during pregnancy, childbirth and postpartum are importants. It is suggested that the population would be concious of the existence of appropriate psychiatric care and specific place in Toamasina to treat puerperal psychosis.