Postpartum psychosis
By Jessica Anne Pressler LCSW
Postpartum psychosis, sometimes called postnatal psychosis, or puerperal psychosis, is a perinatal mental disorder that has a biological trigger that occurs after childbirth, usually within two weeks, and often lasts for months, even years. It is a dangerous mental health condition where a new mother loses her sense of reality, suffers from hallucinations, mood changes, delusions, disorganized thinking, and paranoia, and may harm herself and her baby.
Postpartum psychosis affects 1 to 2 women out of 1000 after they give birth. Symptoms of postpartum psychosis usually begin within two weeks of childbirth, often hours or days after the baby is born, and are comparable to a bipolar episode. Symptoms may include restlessness and irritability, inability to sleep, audio, visual, and olfactory hallucinations, delusions (thoughts and beliefs that are not true), manic mood (talking and thinking too quickly,) depression, rapidly changing moods, loss of inhibitions, anxiety, paranoia, confusion, feelings of guilt, panic, thoughts of self-harm, aggression, disorganized speaking, catatonic, suicidal ideation and harming their child. Suspected cases should require an immediate evaluation by a psychiatrist. There could be devastating consequences if left untreated, such as the mother killing her baby and herself.
A mental health and medical professional may make diagnoses based on observation of symptoms, patients’ description of their symptoms, family description of symptoms, blood tests and scans, and questionaries. Women are more at risk for postpartum psychosis if diagnosed with bipolar disorder. “Postpartum psychosis typically resembles a manic or mixed mood episode with psychotic symptoms and is strongly associated with bipolar I disorder” (DSM-5-TR.) Other risk factors are a family history of a postpartum psychotic episode, a family history of bipolar disorder, a history of schizophrenia, family history of schizophrenia, first-time mothers, and woman who have had a previous postpartum psychotic episode will more likely have an increased risk of reoccurrence with each successive pregnancy.
Treatment options for someone diagnosed with postpartum psychosis include medications such as antipsychotics to reduce hallucinations and mood stabilizers when symptomatic. Some medications can be used before onset, prophylactically, such as Lithium during pregnancy or immediately postpartum if high risk. A pregnant high-risk patient should see a psychotherapist and psychiatrist specializing in postpartum depression and psychosis during pregnancy and after or as soon as symptomatic. The family would benefit from psychotherapy as well and or support groups to help them cope and learn skills to help patients. Electroconvulsive therapy is also used as treatment.
Postpartum psychosis is a severe mental illness and can be dangerous for the mother and her children. A patient may not be able to recognize the symptoms and may need a family member or friend to recognize the symptoms and seek help from a mental health professional or medical professional immediately. Family and friends can provide the eyes and ears to protect the mother and baby while helping them get the support they need, which may include inpatient care. If someone suspects that a new mother is suffering from postpartum psychosis, they must seek help immediately. They can go to ER, call 911, call PSI Helpline 1-800-944-4773 or text that number and text the word help or call 988 suicide hotline and separate the baby from the mother in a supportive manner until safe. When helping someone you suspect has postpartum psychosis stay calm, don’t argue, and don’t leave them alone or alone with their child. Seek support and get help immediately. If adequately treated, a mother can make a full recovery. Still, she and her family will need ongoing support and be aware that if she becomes pregnant again, she may become ill again. While postpartum psychosis can be cured, some mothers are later diagnosed with bipolar disorder. Once a woman has had a postpartum psychotic episode, they have a higher risk of reoccurrence with each successive pregnancy.
All mental health and medical staff in all settings, including hospital ER, birthing centers, private officers, clinics, urgent care, pediatric settings, etc., anyone who cares for pregnant and new mothers and babies should be aware of postpartum psychosis, have a way to make an assessment and where immediate support is available if needed. There needs to be better education for pregnant women and their families so they will be better able to recognize postpartum psychosis and know where to seek immediate support and care. If someone is at high risk for postpartum psychosis, has been diagnosed with bipolar disorder, has a family with bipolar disorder, or a history or family history of postpartum psychosis, they should be seen during pregnancy by a psychiatrist who specializes in perinatal care and follows the mother after the baby is born. Finally, there must be recognition that this is a biological illness and not the mother’s fault to eliminate any shame. Hence the mother and family feel comfortable seeking support throughout the pregnancy and after.
-Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Provider, Lauren M. Osborne, MD, September 1, 2019, National Library of Medicine.
-DSM-5-TR Diagnostic and Statistic Manual of Mental Disorders fifth edition
-Postpartum Psychosis: Symptoms and Resources October 20,2016, Healthline
-Postpartum Psychosis Help, PSI Postpartum Support International
-Postpartum Psychosis: What it is, Symptom and Treatment-Cleveland Clinic, September 13,2022
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