Puerperal (postpartum) psychosis

Pelvis | Obstetrics and Gynaecology | Puerperal (postpartum) psychosis (Disease)


Postpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth. A typical example is for a woman to become irritable, have extreme mood swings and hallucinations, and possibly need psychiatric hospitalization.

Often, out of fear of stigma or misunderstanding, women hide their condition. The relatively common non-organic form, still prevalent in Europe, North America and throughout the world, is sometimes called puerperal bipolar disorder, because of its close link with manic depressive (bipolar) disorder; but some of these mothers have atypical symptoms which come under the heading of acute polymorphic (cycloid) psychosis. These psychoses are endogenous, heritable illnesses with acute onset, benign episodic course and response to mood-normalizing and mood-stabilizing treatments.

The onset is abrupt, and symptoms rapidly reach a climax of severity. Manic and acute polymorphic forms almost always start within the first 14 days, but depressive psychosis may develop somewhat later.

Causes and Risk factors

Researchers think puerperal psychosis is somehow caused by changes in hormones that happen during pregnancy and birth, but as yet they do not know what these changes are. Studies have shown that puerperal psychosis is genetic – that women whose mothers or close relatives experienced psychosis after birth are more at risk of developing it themselves. However, researchers do not yet know which genes are involved.

Researchers are trying to understand more about the causes of puerperal psychosis – why one woman with bipolar disorder will experience it, and another woman with the same diagnosis won’t.

Diagnosis and Treatment

Treatment for puerperal psychosis involves antipsychotic medication and drugs used to treat bipolar disorder. Women may not be able to breast-feed while taking some medication, and their psychiatrist should give advice about this.

ECT (electroconvulsive therapy) is sometimes used to treatment symptoms of puerperal psychosis that do not respond to medication (see Other treatments page for information about ECT). With treatment, most women become well within several months. ...

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