Postpartum psychosis

Postpartum psychosis (PP) is a psychiatric condition that develops shortly after childbirth. It occurs in approximately 1 to 2 out of every 1,000 births.

What is postpartum psychosis?

Postpartum psychosis is a type of postpartum mental health condition that involves a loss of touch with reality. During PP, women may show significant changes in mood, thought process, and behavior. PP is a serious condition that is treated with immediate hospitalization. 

Signs and symptoms

Postpartum psychosis typically occurs shortly after giving birth. It usually begins within the first 48 hours and 2 weeks postpartum. Symptoms of PP include:

  • Changes in mood

Women with PP may experience symptoms of a manic episode, which can include increased energy, euphoria, grandiose thinking and behavior, and an inability to sleep. Some women may have rapid changes in mood, where they may fluctuate between emotional highs and lows. 

  • Hallucinations

Hallucinations are altered sensory experiences that are unreal, but feel real to the person experiencing them. They may involve hearing or seeing things that are not actually there. For example, a woman may believe that she is hearing voices telling her that she is a bad mother or to hurt her baby. 

  • Delusions

Delusions are false beliefs that persist despite any evidence against them. During PP, women may have delusions about their baby, such as the belief that the baby is being harmed by the mother’s breast milk. They may become frustrated if family, friends, or treatment providers try to convince them that the delusions are untrue.

  • Confusion

Women with PP may say or do things that seem odd or out of character. They may appear severely confused or disorganized. Usually this is a drastic change from the woman’s typical behavior.

The impact of postpartum psychosis

Postpartum psychosis can affect women, families, and babies in many ways. If PP is not properly treated, it can negatively affect a woman’s marriage, relationships, and ability to bond with her baby. Children of mothers with untreated PP may develop developmental delays and behavioral problems as they get older. Women with untreated PP may continue to experience mental health issues in the future. 

Some women who experience PP may have thoughts of harming themselves or their baby. There have been some cases where mothers have committed suicide or infanticide. It is important to get help immediately if you suspect that you or someone you know is suffering from PP.

Postpartum psychosis
Getting treatment for postpartum psychosis significantly decreases the risk of harm to the mother and baby.

How does postpartum psychosis differ from other perinatal mood and anxiety disorders?

Postpartum psychosis is sometimes misdiagnosed as another perinatal mood and anxiety disorder, like postpartum depression or obsessive-compulsive disorder (OCD). 

Postpartum depression involves feeling sad or down for several weeks. Women with PP may also feel depressed at times, but psychotic symptoms like hallucinations, delusions, and severe confusion are also present. Women with postpartum depression do not experience psychotic symptoms.

Postpartum-induced OCD is also sometimes confused with PP. OCD involves intrusive thoughts that may involve harming the baby. However, the main difference between the two disorders is that women with postpartum OCD feel disturbed by their thoughts and are therefore unlikely to act on them. They actively try to avoid anything that may lead them to act on their thoughts. Women with PP do not experience their delusions as disturbing, which increases their risk of harming themselves or the baby. 

Only a professional can determine if a woman has PP or another perinatal mood or anxiety disorder. If you think that you or someone you know has PP, read on to find out how to get help. 

Who is at risk of postpartum psychosis?

Shortly after giving birth, women experience a significant change in hormone levels that can affect their emotional state. While all women experience this change after childbirth, certain women may be at higher risk of developing a postpartum mental health condition. Women who have a history of bipolar disorder have a much higher risk of developing PP. In fact, between 72 and 80% of women who develop PP have a past bipolar disorder diagnosis. Family history of PP or bipolar disorder can also increase your risk of developing the condition. 

Postpartum psychosis
Treatment for postpartum psychosis typically involves hospitalization followed by aftercare.

Getting help for postpartum psychosis

Postpartum psychosis is a serious condition that requires inpatient hospitalization to stabilize the mother’s emotional state. If you think that you or someone you know may be experiencing PP, speak with a physician, OBGYN, psychiatrist, or therapist, who can evaluate and determine what course of treatment is necessary. If you have serious concerns about a mother’s risk of harm to herself, her baby, or others, call 911 immediately. You can also call Postpartum Support International’s Postpartum Psychosis helpline at 1-800-273-8255.

Hospitalization

When a woman is admitted to the hospital for an episode of PP, she will first meet with the treatment team for an assessment. She will undergo a physical exam and series of tests to determine if there are any medical causes of her condition. Once a woman is diagnosed with PP, a psychiatrist or psychiatric nurse practitioner may consider hormone therapy and/or medication. Different types of psychiatric medication are typically prescribed for PP, such as anti-anxiety medications, mood stabilizers, and antipsychotics. The treatment team will also take steps to address a woman’s sleeping habits, since stabilizing sleep is important for recovery. 

Psychotherapy, including individual, family, and group therapy, is also an important component of treatment. Once a woman’s symptoms have resolved, the hospital treatment team will help her and her family develop an aftercare plan. 

Aftercare

Treatment for PP must continue even after a woman leaves the hospital. Prior to leaving the hospital, the mother will be set up with a therapist and psychiatrist, who will continue prescribing her medication. The mother may also be referred to a self-help group. The Action on Postpartum Psychosis offers an online peer support group where mothers who have experienced PP can seek support from one another. 

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Postpartum psychosis is a serious, but treatable condition. If someone you know is showing signs of PP, consult with a medical or psychiatric professional right away. With the proper help, a mother with PP can recover.

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