Rarely, symptoms of psychosis appear in women who are in the immediate postpartum period. Although psychiatric manuals do not list postpartum psychosis as a specific disorder, many professionals use this concept to refer to such situations.

In this article we will analyze the main symptoms and causes of puerperal psychosis , as well as other of its basic characteristics. We will also briefly review the therapeutic options currently available to manage this problem.

What is postpartum psychosis?

Postpartum psychosis is a type of psychotic disorder that occurs in women who have just had a baby, usually within two weeks of delivery. It is characterized by symptoms typical of psychosis such as hallucinations, delusions, disorganization of thought , behavioral disinhibition, and catatonia.

In psychotic disorders there is a loss of contact with reality that can manifest itself in different areas and has a variable severity. It is believed that there is a strong genetic influence that determines the development of symptoms of psychosis.

This form of psychosis was described by the German obstetrician Friedrich Benjamin Osiander in 1797. In the past, postpartum psychosis was attributed to infections, thyroid disorders, or eclampsia, a seizure disorder of pregnancy. Although these hypotheses have been ruled out (except for the thyroid), the causes remain unclear.

It is a relatively rare disorder, given that affects 1 in every 1000 women who give birth . In comparison, postpartum depression, a subtype of major depressive disorder, occurs in approximately 15% of mothers. Although psychotic symptoms may occur in the context of postpartum depression, these are different disorders.

The DSM manuals do not include the diagnosis of puerperal psychosis; using these guidelines these cases should be classified as “Psychotic Disorders Not Specified”. In the ICD-10 we find the category “Mental and behavioral disorders in the puerperal period”, which also includes postpartum depression.

Common signs and symptoms

The referred symptoms and observable signs of postpartum psychosis vary greatly from case to case, and even throughout the course of the disorder in the same person. Opposing symptoms, such as euphoria and depression, sometimes occur together.

The most frequent initial signs of postpartum psychosis include the appearance of feelings of euphoria, reduction in the amount of sleep, mental confusion and verbiage.

In addition to being classifiable in a psychotic-type picture similar in nature to that of schizophrenia or schizoaffective disorder, the usual symptoms of puerperal psychosis sometimes also resemble those of mania and depression , the main mood disorders.

  • Delusions and other strange beliefs
  • Hallucinations, especially auditory
  • Paranoia and suspicion
  • Irritability and emotional instability
  • Low mood, even depressive
  • Mania: feelings of euphoria, increased energy, and psychological agitation
  • Rapid thinking and severe confusion
  • Communication difficulties
  • Motor hyperactivity and behavioral disinhibition
  • Decreased need or ability to sleep
  • Lack of recognition of alterations
  • Increased risk of suicide and infanticide

Causes and risk factors

Research shows that puerperal psychosis is associated with schizophrenia, bipolar disorder and schizoaffective disorder ; about one third of women with these disorders suffer severe psychotic episodes after childbirth. In addition, people with postpartum psychosis have a 30% chance of having another episode in subsequent pregnancies.

It is believed that there is a genetic component to this disorder, since the fact that a close relative has been diagnosed with puerperal psychosis increases the risk of developing it by approximately 3%. A family history of depression in pregnancy or postpartum, psychotic-affective disorders, and thyroid dysfunction are also risk factors.

However, half of the women who suffer from postpartum psychosis have no risk factors; one hypothesis that could explain this would be that which associates this disorder with the hormonal and sleep cycle changes that occur after childbirth . First-time mothers seem to have a higher probability of developing this type of psychosis.

Treatment of postpartum psychosis

When a case of postpartum psychosis is detected, it is most common for the hospital stay to be extended, or for the mother to be hospitalized again. In general, the management of this alteration is carried out through pharmacotherapy, although there are emergency psychological intervention programs for psychosis that can be very useful as a complement.

Among the drugs used to treat this disorder, two categories stand out: , antipsychotics and mood stabilizers , reference psychopharmaceuticals in bipolar disorder. Antidepressants may also be useful in managing symptoms such as depressed mood, irritability, sleeping difficulties and cognitive problems.

Drug-resistant cases that are also severe, such as those with a clear risk of suicide, are sometimes treated with electroconvulsive therapy.

Most people who suffer from this disorder recover fully within six months to a year, while the severity of symptoms usually decreases markedly within three months of delivery. The risk of suicide remains high during the recovery period .