An investigation into puerperal psychoses in black women admitted to Baragwanath Hospital

Objectives. Puerperal psychosis was studied in black African women at Barag wanath Hospital in Johannesburg. Design. A retrospective study analysed the clinical notes of 314 cases of p uerperal psychosis seen over previous years. A prospective study researched 67 cases of puerperal psychosis referred during a full calendar year. A co ntrol group of 98 patients was matched with the prospective study patients for age, marital status, parity and month of delivery. Results. The incidence (2 - 3 cases per 1 000 births), onset and pattern of illness are all remarkably similar to that described in the international literature. Confirmed risk factors were a primiparous patient; a family his tory of psychiatric illness; and a personal psychiatric history, particular ly a history of mania. Additional risk factors found in this study were sub stance dependence; a medical illness; the season of the year; a male child; and psychosocial stress including need for intensive medical care for the baby or death of the baby. Conclusion. The conclusion reached is that the puerperal psychoses are undi fferentiated psychoses, usually mood disorders, showing some special sympto matology, and are precipitated in constitutionally predisposed patients by the physiological factors of the involutionary period.