Postpartum psychosis

Postpartum psychosis (also known as puerperal psychosis or postnatal psychosis) is a psychiatric emergency that warrants immediate intervention, due to the risks posed to the mother and the infant's safety.

Consider this diagnosis in postpartum women, particularly in the first 4 weeks postpartum, who demonstrate a sudden change in mental status, agitation, confusion, or insomnia, accompanied by mood features such as anxiety, mania, irritability, or depression.

A personal history of bipolar disorder and a personal history of postpartum psychosis after previous pregnancies are significant risk factors for the development of postpartum psychosis.

If you suspect postpartum psychosis, arrange immediate psychiatric evaluation and safety assessment, with particular attention paid to the risks of suicide and infanticide. Consult children's services if there is concern regarding risk to the baby or other children in the mother's care. Admit the patient to inpatient psychiatry for urgent assessment. Strongly consider initiation of interim treatment while awaiting psychiatric assessment if the patient is significantly distressed or agitated, or may be a danger to themselves or others (follow guidance from the psychiatric team where possible).

Psychotropics are the mainstay of treatment, and treatment should be individualized to the patient and adjusted as required according to response. Electroconvulsive therapy (ECT) may be an option for select patients.

Psychological support is integral to recovery, and may include formal psychological support as well as emotional support from family members and friends, which should continue following stabilization and discharge of the patient.

Treatment and monitoring should continue for at least 6-12 months following remission given the high risk and dangers of relapse.

​Postpartum psychosis refers to the development of psychosis (a break in reality perception that can include delusions, hallucinations, and changes in speech and behavior) in the postpartum period. Postpartum psychosis differs from other forms of psychosis in numerous ways, including its more sudden development, typically in the first 4 weeks postpartum; potential waxing and waning consciousness fluctuations; and significant mood components such as anxiety, irritability, depression, or mania.[1]Osborne LM. Recognizing and managing postpartum psychosis: a clinical guide for obstetric providers. Obstet Gynecol Clin North Am. 2018 Sep;45(3):455-68. https://pmc.ncbi.nlm.nih.gov/articles/PMC6174883 http://www.ncbi.nlm.nih.gov/pubmed/30092921?tool=bestpractice.com ​ Women experiencing postpartum psychosis typically do not recognize that their behaviors or thoughts are abnormal.