Postpartum Psychosis

Postpartum psychosis (puerperal psychosis or postnatal psychosis) is a serious mental illness which occurs in the days or weeks following childbirth.

What is postpartum psychosis?

Postpartum psychosis is a serious mental illness which occurs in a few women in the days or weeks following childbirth. It is extremely important to diagnose and treat it early, as it is a severe illness which puts both the mother and the new baby at risk.

It happens to about one out of every thousand women after having a baby. It is completely different to baby blues and postnatal depression. It usually starts within the first month after the baby is born.

What are the symptoms of postpartum psychosis?

“Postpartum” means “after childbirth”. “Psychosis” means you lose touch with reality in a way which causes your thoughts and actions to become bizarre and, in some cases, dangerous. When psychosis happens after having a baby, there may be a number of symptoms, such as:

• Mood changes. Your mood may become low or excessively high. If you feel low, this may make you feel down and tearful. You may not want to do anything and you may not want to see other people. In other people with postpartum psychosis, mood may be excessively high, or “manic”. If this is the case you may feel elated, jittery, agitated, and unable to keep still or stop talking. Your mood may suddenly change between being low and being high.
• Difficulty in concentrating or focusing. You may feel confused.
• Trouble sleeping.
• Paranoid thoughts. You may feel that you cannot trust family or friends, and that there is a conspiracy against you. You might feel people are going to harm you in some way, or stop you doing what you need to do.
• Hallucinations. This means experiencing things which aren’t real. For example, you might hear voices which nobody else can hear, or see things or people nobody else can see. You may also smell or feel things which are not real.
• Odd beliefs. You might have unusual beliefs (delusions). For example, you might think you or your baby are possessed, or particularly special in some way. You might think you have lots of money which you don’t actually have. You might develop a strong religious belief that you never had before. You might feel you have to harm yourself or your baby. You might feel you are getting messages from God, or from the radio or TV, telling you to do certain things.
• Losing normal social inhibitions. You may behave in a way which seems perfectly reasonable to you but that causes concern to everybody around you.
• Not recognising that you are unwell and not your normal self.

What causes postpartum psychosis?

It is more likely if someone in your family has had postpartum psychosis, so your genetic makeup might be part of the reason. It could also be that hormones are involved, or the lack of sleep which tends to come with having a new baby. It could be a number of things that cause the condition when they come together.

You are more likely to develop postpartum psychosis if:

• You have had postpartum psychosis in the past, after a previous pregnancy.
• A close relative has had postpartum psychosis.
• You have been diagnosed with bipolar disorder in the past.
• You have been diagnosed with schizophrenia in the past.

How is postpartum psychosis treated?

Postpartum psychosis is regarded as an emergency, meaning it is a serious condition needing urgent treatment. If you are diagnosed with postpartum psychosis you would normally be admitted to hospital for specialist care. In the UK, ideally you would be admitted to a specialist mother and baby unit. Normally your baby would be admitted with you, and you would have help from the specialist staff on the unit with looking after your baby.

Usually medication is needed to treat postpartum psychosis. An anti-psychosis medicine is usually used. A mood-stabilising medicine may also be helpful. If you need one of these medicines and are breast-feeding your baby, your specialist will discuss options with you.

You and your baby will need plenty of support, both while you are an inpatient, and once you are discharged. In the UK, your health visitor and the community psychiatric nurse (CPN) from your mental health team will help provide all of the practical support and advice you need.

Keep in mind that if you become pregnant again in the future, you are likely to develop postpartum psychosis again.

What is the outlook?

The outlook is fortunately usually very good. As long as women with postpartum psychosis are treated early, they usually make a full recovery. Normally they return to being able to look after their family in a healthy state of mind.