What is Postpartum Psychosis?

Woman looking down in distress
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What is Postpartum Psychosis?

The reproductive years are a time of intense psychological vulnerability for women, with a significant number of psychiatric admissions occurring more around childbirth than any other time in the female life cycle (Wisner, Gracious, Piontek, Peindl, & Perel, 2003). One of the rarer presentations seen during this time period is postpartum psychosis. Postpartum psychosis may be indicated by a variety of characteristics including extremely disorganized thinking, mania, insomnia, hallucinations (seeing or hearing things that are not there), irritability, paranoia and suspiciousness, or difficulty communicating at times (PSI, 2023). Additionally, people may notice rapidly changing moods from euphoria to melancholia (Friedman, Reshnick, & Rosenthal, 2009). It is important to note that a woman experiencing psychosis is experiencing a break from reality, and in this psychotic state, the hallucinations, delusions, and beliefs make sense to her (PSI, 2023). Postpartum psychosis is markedly different from psychotic episodes unrelated to childbirth due to a few factors.  Importantly, postpartum psychosis may have a waxing and waning presentation where a woman’s thoughts may fluctuate in any given moment from clarity to delusion (Brockington, 1996).

Tragically, however, during episodes of postpartum psychosis there is a risk of suicide and infanticide. At times these mothers may take the lives of their babies due to the belief that the children were in danger, and this may be a contributing factor to mothers taking the lives of their babies out of fear for their children’s safety in current circumstances  (Forensic, 2016). Among women who are experiencing psychosis, it is not unusual for the mother to attempt suicide concurrently or immediately after taking her child’s life. This perhaps may be due to the delusional belief that she cannot leave her child alone without her either in the earthly world or beyond (Forensic, 2016).

Due to these considerations, it is imperative to seek immediate medical attention in the event of worry or concern of postpartum psychosis. Postpartum psychosis is considered a psychiatric emergency, and immediate assessment  is imperative.

What is the Prevalence of Postpartum Psychosis?

Fortunately, postpartum psychosis is a relatively rare presentation with a first-lifetime onset rate of 0.25 to 0.6 per 1,000 births (Bergink, 2016). While this prevalence rate is low, the relative risk for the first onset of psychosis is 23 times higher within 4 weeks after delivery compared with any other period in a woman’s life (Munk-Olsen, 2006). After an initial episode, approximately 20%-50% of women do not experience further episodes of psychosis (Munk-Olsen, 2006).  The remaining women may have episodes outside of the perinatal period and diagnostically typically fall within the bipolar spectrum (Bergink, 2016).

What are the Risk Factors for Postpartum Psychosis?

When examining risk factors for postpartum psychosis, it is critical to take into account pre-existing psychosis and bipolar illnesses. Early symptoms of postpartum psychosis may include insomnia, mood fluctuation, and irritability with emergence of mania, depression, or a mixture of both (Bergink, 2016). Although rapid mood fluctuations can be a marker of this illness, women suffering from postpartum psychosis often have symptoms that are atypical in patients with bipolar disorder. For example, delusions and hallucinations are often related to themes of childbirth, and the disorganized, unusual behavior, and obsessive thoughts are often regarding the newborn baby.

Postpartum psychosis is notable for its “delirium like appearance,” meaning sudden confusion or a sudden change in mental state with cognitive symptoms such as disorientation, confusion, derealization or feeling detached from surroundings, and depersonalization or feeling like one is observing themselves from outside of their body or a sense that things around oneself are not real (Bergink, 2016). Typically there is a lower incidence of psychiatric symptoms of thought insertion or experiencing one’s own thoughts as someone else’s, hallucinatory voices giving running commentaries, or social withdrawal (Bergink, 2011).

Disruptions of circadian rhythms are quite common in postpartum psychosis. Researchers regularly report that women with psychosis have severe sleep disturbances, which is a significant warning symptom for postpartum psychosis. In first time mothers, the early postpartum period is characterized by more awakenings, a later onset of restorative REM sleep, and sleep loss (Lee, 200). Postpartum psychosis is a psychiatric condition with onset factors related to specific psychological changes, such as hormonal, immunological, and circadian rhythms leading to disease in genetically vulnerable women (Bergink, 2016).

Screening for Postpartum Psychosis 

Thorough and effective screening from a qualified professional who specializes in reproductive mental health for postpartum psychosis is critical. Women with postpartum psychosis require an intensive and higher level of care to oversee treatment. It is imperative to educate the patient and her family about early symptoms of psychosis, such as paranoid ideas, thoughts that others might consider usual, or strong feelings of guilt. Assessment must include direct questions about suicidal and infanticidal thoughts. Examinations must also include assessment for other medically treatable causes of psychosis, such as acute infection, blood loss, etc.  If you or anyone you know is concerned about postpartum psychosis, please seek immediate medical attention for full screening.

Treatment of Postpartum Psychosis

Care for the postpartum women must involve the women’s family and significant others. The goals of treatment are not only to reduce psychiatric symptoms but to also increase self esteem, confidence in the mother, and social and family functioning, as well as infant health and development. Treatment typically includes intensive medical support including medication regimes, psychotherapy, and family support. Support around stress management, feeding, and strategies for protecting adequate sleep to maintain a stable circadian rhythm is crucial.  Postpartum psychosis is a treatable illness, and women who are able to access help typically have considerably better outcomes (Boyce & Barriball, 2010). The majority of women who experience postpartum psychosis do not harm themselves or someone else (PSI, 2023).

Of note, there are less than 30 published studies describing treatment of postpartum psychosis, and the majority of these studies include less than 10 patients. There is an ongoing need for continued research on this presentation to be able to fully understand how to most effectively treat this illness. On a hopeful note, in the studies that do exist, the authors observe that nearly all patients (98.4%) achieved complete remission, with a medial episode duration of 40 days (Berginek, 2016). Postpartum psychosis is a temporary condition and is treatable with professional help. It is an emergency and it is essential to receive immediate help. If you or someone you know is suffering from what might be postpartum psychosis, call your doctor or an emergency crisis hotline right away so that you can get the help that is needed.

Crisis Hotlines

  • National Crisis Text Line
    • Text HOME to 741741 from anywhere in the USA, anytime, about any type of crisis
  • Natonal Suicide Prevention Hotline & Website

Postpartum Psychosis Support Services

Online Resources

  • Resources include information, a HelpLine (800-944-4773) and access to various support services. NOTE: PSI is not a crisis hotline. If you are currently experiencing a crisis: Call your physician or your local emergency number (911); Text HOME to 741741 from anywhere in the USA; or Call National Suicide Prevention Lifeline 1-800-273-TALK (8255).
  • PSI Bookstore*for books, including those on postpartum psychosis for providers, advocates, and families.

Social Media


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