Postpartum Psychosis

Postpartum psychosis is a rare, but serious, psychiatric emergency that occurs in approximately 1-2 out of 1000 births. This can include miscarriages and still birth.

Its onset is generally sudden and occurs sometime within the first 4 weeks postpartum, but more commonly in the first 2 weeks[1].

Symptoms

There is a range of symptoms that present with postpartum psychosis:

  • Insomnia or decreased need for sleep
  • Mood changes
  • Poor concentration
  • Excited or elated mood
  • Irritable
  • Depression or sadness
  • Hallucinations
  • Delusions
  • Confusion
  • Unusually or excessively social or talkative
  • Excessively energetic
  • Busy mind or racing thoughts
  • Paranoia
  • Displaying uncharacteristic behaviour

Please note that this list is not exhaustive. To hear about parents’ personal stories of postpartum psychosis, click here.

Risk Factors

Currently, the risk factors associated with postpartum psychosis are poorly understood and more research is needed to reliably predict who is susceptible. However, as it stands, a personal or family history (generally mother or sister) of bipolar disorder type 1 or Schizoaffective disorder, a previous psychotic episode or previous postpartum psychosis are the greatest risk factors [2-9]. If any of these risk factors apply to you, it’s important to talk to your health care provider as soon as possible to discuss further.

Treatment

Like all Perinatal Mood and Anxiety Disorders, it is important to know that this isn’t your fault. There is nothing you did to bring this on.

If you have any risk factors and/or you begin to experience symptoms, you need to be seen urgently. Please contact your health care provider immediately, go to your local emergency department, and/or call your local emergency number (e.g., 911). If you have already been seen, or seen recently, by a health care professional and your symptoms persist or worsen, you need to be seen again.

Treatment may consist of in-patient treatment (until stabilized) and antipsychotic medication or mood stabilizers. In addition, psychoeducation and other outpatient support (e.g., support worker, mental health nurse, or psychosis coordinator) may all be helpful depending on the services in your area. Please know that each person will respond differently and have different treatment needs. There is no one universal medication or treatment plan. It’s important to discuss your individual needs with your health care provider. Again, postpartum psychosis is a temporary and treatable disorder with professional help.

If you are in need of immediate assistance, please contact your health care provider, 911 or local emergency number, go to your local hospital, contact Crisis Services Canada (1-833-456-4566), or National Suicide Prevention Lifeline (1-800-273-8255).

Get Help

Resources

Action on Postpartum Psychosis

Royal College of Psychiatrists – Postpartum Psychosis

DISCLAIMER: The content of Postpartum Support Yukon’s website, posts, and blogs does not constitute medical advice, nor is it an emergency service. If you have concerns about any health or medical condition, diagnosis, or treatment, you should consult with a licensed healthcare provider. If you are experiencing a medical emergency, please call, or go to, your health care provider, local emergency department, 911 or your local emergency number immediately. Postpartum Support Yukon is intended for informational purposes only.

References

  1. Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662–73.

2. Blackmore ER, Rubinow DR, O’Connor TG, Liu X, Tang W, Craddock N, Jones I. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord. 2013;15:394-404. 

3. Jones I, Craddock N. Do puerperal psychotic episodes identify a more familial subtype of bipolar disorder? Results of a family history study. Psychiatr Genet. 2002;12:177–80.

4. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014; 384: 1789-99.

5. Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, Jones I. Perinatal Episodes across the Mood Disorder Spectrum. JAMA Psychiatry. 2013;70:168-75.

6. Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2016;173:117-27.

7. Di Florio A, Gordon-Smith K, Forty L, Kosorok MR, Fraser C, Perry A et al. Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum.Br J Psychiatry. 2018; 213: 542-547.

8. McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V  et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum.  J Psychopharmacol. 2017; 31: 519-552.

9. National Institute for Health and Care Excellence (2014) Antenatal and postnatal mental health: Clinical management and service guidance. NICE Guidelines CG192. http://www.nice.org.uk/ guidance/CG192