Williams has found that the puerperal psychoses are usually
characterized by great excitement during the first few days, associated
with all sorts of hallucinations. Later, the maniacal symptoms disappear
and the patient passes into a condition of depression with frequently
suicidal tendencies.
Lewis has found that there are seldom any prodromal, usually of sight
and sound, and great motor and mental excitement, appear; later motor
agitation, subsultus, expressions of fear and uneasiness. Toxic cases
are similar, but not so severe. Progress toward recovery is
gradual—hallucinations disappear and lucid intervals occur. Lactational
cases come on slowly, hallucinations at first few and later more
constant; not a type of melancholia, but a mild, exalted mania, with
frequently suicidal tendencies.
Hirst’s cases have been of mania, melancholia or profound lethargy,
stupidity and mental confusion, and Webster’s experience has been about
the same.
Edgar feels that while most of the cases have been classed as mania,
they are in reality hallucinatory insanity.
De Lee has found melancholia with suicidal intent most common, but has
also observed mania with infanticidal tendencies, while Vinay holds that
the maniacal forms are the most frequent.
Tweedy & Wrench have found that insanity of the puerperium is always
associated with either severe anæmia from hemorrhage or with sepsis. The
patient is first irritable and uneasy about unknown dangers. She had a
headache, is constipated, she may refuse food or to see her child or
husband, and sleeps badly, and finally becomes definitely maniacal and
may have suicidal tendencies. During lactation the patient becomes
gloomy, sleeps badly, and is constipated. Definite melancholia develops
with delusions and suicidal tendencies.