Postpartum psychosis: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis
- Jennifer Payne, MD
Jennifer Payne, MD
- Associate Professor of Psychiatry
- Johns Hopkins School of Medicine
During the postpartum time period, women are at an increased risk of the onset or recurrence of psychiatric illness, including mood, anxiety, and psychotic disorders. Postpartum psychosis (or puerperal psychosis) is most often seen in patients that have been or will be diagnosed with bipolar disorder, but can also occur in women with a major depression with psychosis, schizophrenia, or schizoaffective disorder. A subset of women experience isolated postpartum psychosis that does not progress to mood or psychotic episodes outside the postpartum time period .
The clinical picture of postpartum psychosis includes rapid onset of psychotic symptoms including hallucinations and delusions, bizarre behavior, confusion, and disorganization that may appear to be delirium. Postpartum psychosis constitutes a medical emergency and generally requires rapid intervention and hospitalization, as well as a comprehensive medical evaluation and psychiatric management.
The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of postpartum psychosis are reviewed here. The treatment of postpartum psychosis is discussed separately, as are individual psychotic disorders. The epidemiology, clinical manifestations, assessment, and diagnosis of other serious mental disorders with psychosis are also described separately.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Sep 13, 2016.References
- Wesseloo R, Kamperman AM, Munk-Olsen T, et al. Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Am J Psychiatry 2016; 173:117.
- Terp IM, Mortensen PB. Post-partum psychoses. Clinical diagnoses and relative risk of admission after parturition. Br J Psychiatry 1998; 172:521.
- Videbech P, Gouliaev G. First admission with puerperal psychosis: 7-14 years of follow-up. Acta Psychiatr Scand 1995; 91:167.
- Brockington I, Kumar R. Motherhood and Mental Illness, Academic Press, London 1982.
- Brockington I. Postpartum psychiatric disorders. Lancet 2004; 363:303.
- Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry 1987; 150:662.
- Tschinkel S, Harris M, Le Noury J, Healy D. Postpartum psychosis: two cohorts compared, 1875-1924 and 1994-2005. Psychol Med 2007; 37:529.
- Blackmore ER, Rubinow DR, O'Connor TG, et al. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord 2013; 15:394.
- 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.
- Munk-Olsen T, Laursen TM, Meltzer-Brody S, et al. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry 2012; 69:428.
- Harlow BL, Vitonis AF, Sparen P, et al. Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations. Arch Gen Psychiatry 2007; 64:42.
- Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry 2001; 158:913.
- Nonacs R, Cohen LS. Postpartum mood disorders: diagnosis and treatment guidelines. J Clin Psychiatry 1998; 59 Suppl 2:34.
- Viguera AC, Nonacs R, Cohen LS, et al. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry 2000; 157:179.
- Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007; 164:1817.
- Jones I, Craddock N. Searching for the puerperal trigger: molecular genetic studies of bipolar affective puerperal psychosis. Psychopharmacol Bull 2007; 40:115.
- Munk-Olsen T, Laursen TM, Mendelson T, et al. Risks and predictors of readmission for a mental disorder during the postpartum period. Arch Gen Psychiatry 2009; 66:189.
- Bergink V, Burgerhout KM, Weigelt K, et al. Immune system dysregulation in first-onset postpartum psychosis. Biol Psychiatry 2013; 73:1000.
- Weigelt K, Bergink V, Burgerhout KM, et al. Down-regulation of inflammation-protective microRNAs 146a and 212 in monocytes of patients with postpartum psychosis. Brain Behav Immun 2013; 29:147.
- Sharma V, Smith A, Khan M. The relationship between duration of labour, time of delivery, and puerperal psychosis. J Affect Disord 2004; 83:215.
- Bilszta JL, Meyer D, Buist AE. Bipolar affective disorder in the postnatal period: investigating the role of sleep. Bipolar Disord 2010; 12:568.
- Spinelli MG. Postpartum psychosis: detection of risk and management. Am J Psychiatry 2009; 166:405.
- Chandra PS, Bhargavaraman RP, Raghunandan VN, Shaligram D. Delusions related to infant and their association with mother-infant interactions in postpartum psychotic disorders. Arch Womens Ment Health 2006; 9:285.
- CEMD. Confidential inquiries into maternal deaths: why mothers die, 1997-1999. Royal College of Obstetricians and Gynaecologists. London 2001.
- Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Womens Health (Larchmt) 2006; 15:352.
- Kumar R, Marks M, Platz C, Yoshida K. Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions. J Affect Disord 1995; 33:11.
- Parry BL. Postpartum psychiatric syndromes. In: Comprehensive Textbook of Psychiatry, 6th ed, Kaplan H, Sadock B (Eds), Williams and Wilkins, Philadelphia 1995. Vol 1, p.1059.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Seeman MV. Clinical interventions for women with schizophrenia: pregnancy. Acta Psychiatr Scand 2013; 127:12.
- Bosanac P, Buist A, Burrows G. Motherhood and schizophrenic illnesses: a review of the literature. Aust N Z J Psychiatry 2003; 37:24.
- Bergink V, Burgerhout KM, Koorengevel KM, et al. Treatment of psychosis and mania in the postpartum period. Am J Psychiatry 2015; 172:115.
- Patil NJ, Yadav SS, Gokhale YA, Padwa N. Primary hypoparathyroidism: psychosis in postpartum period. J Assoc Physicians India 2010; 58:506.
- Associated mental disorders
- Risk factors
- CLINICAL MANIFESTATIONS
- Risk of suicide and infanticide
- Psychiatric evaluation
- Medical evaluation
- Differential diagnosis
- - Bipolar disorder
- - Schizoaffective disorder
- - Schizophrenia
- - Major depression with psychotic features
- - Substance use disorders
- - Psychosis due to general medical conditions