(Good Things Utah) Postpartum psychosis is a relatively rare, but very serious illness that can occur postpartum. It’s typically associated with postpartum mood disorders and is considered a psychiatric emergency. Psychosis means that a person has a disconnection with reality, so this might include hallucinations, delusions, and often paranoia. 

Best estimates are that it occurs in 1 out of every 500-1000 births, but considering how many births there are in a year this is affecting a lot of women despite being fairly rare. In 2020 Utah had about 45,000 live births, so statistically as many as 900 women could have been impacted by this very serious condition. 

What are the symptoms? 

Postpartum psychosis typically has rapid onset within 2-4 weeks of delivery, but it can also present itself after a few months, especially if a woman is suffering from postpartum depression. Symptoms of postpartum psychosis can include hallucinations (sometimes these are command hallucinations that tell them to do things), paranoia and suspiciousness, and delusions and strange beliefs.

In postpartum psychosis delusions are often centered around the baby and may have religious preoccupations. These women can have what we call ideas of reference, which means that they are perceiving odd messages from the world around them – like if a commercial comes on the TV it has special meaning to them or they may believe that the person on the TV is communicating directly with them. 

With postpartum psychosis you might see a decreased need for sleep or an inability to sleep, impulsive and erratic behaviors, agitation, rapid mood swings, and irritability. Some women with postpartum psychosis can also have thoughts of wanting to harm their babies.

What causes postpartum psychosis? Can you do anything to avoid it?

Postpartum psychosis is most associated with bipolar disorder, but it can also be associated with postpartum depression. The age of onset of symptoms of bipolar disorder in women is typically in their 20’s, which corresponds to our childbearing years, so for some women postpartum psychosis can be the first indication of a bipolar disorder diagnosis.

There are tremendous hormonal shifts going on in the postpartum period, which can contribute to the unmasking of these symptoms. The hormones are not the cause, the disorder was already underlying. The biggest risk factor for having postpartum psychosis is a personal or family history of bipolar disorder or a previous psychotic episode. 

If someone has had postpartum psychosis they are at very high risk of having it recur with their next pregnancies, so it’s very important to work with a mental health professional during any subsequent pregnancies. 

What treatment options are available?

Due to the symptoms and impaired judgment, this condition typically requires inpatient hospitalization. This diagnosis is considered to be a major risk factor for suicide and infanticide, which is killing one’s child, so seeking care immediately is important.

Medications are necessary for the treatment of postpartum psychosis, usually antipsychotics. Because postpartum psychosis is so highly associated with bipolar disorder, we also often use mood-stabilizing medications or antidepressants as well.

The prognosis is overall very positive. We know that women who seek help sooner and get on medications sooner have better outcomes. This is true not only for postpartum psychosis, but also for other postpartum mood disorders, so it’s very important to ask for help early if you’re struggling postpartum.

 For more information, go to UofUHealth.org/MaternalMentalHealth.

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