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What is postpartum psychosis?

Postpartum psychosis (PPP) is a disorder that is triggered by and begins after childbirth, where the individual experiences psychotic symptoms. It affects 1-2 out of 1,000 women.

Postpartum psychosis is closely related to postpartum depression.

What does PPP look like?

Risk Factors

  • Giving birth
  • History of bipolar disorder - 20-30% of women with a prior diagnosis will experience PPP
  • History of PPP
  • Family history of bipolar disorder
  • Sleep loss
  • First pregnancy

Prognosis

  • Prognosis is generally poor, with 40% of individuals not having retained full working capacity due to ongoing symptoms, after 10 years of onset of PPP
  • Psychosis can reoccur, within and outside the context of pregnancy (30-50% chance of reoccurring the next delivery)
  • Higher rates of suicide and infanticide due to command hallucinations and/or delusions that the infant is possessed
  • Prognosis is better if symptoms occur within 4 weeks of delivery

Differential Diagnosis

  • Baby blues
  • Postpartum depression
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Delirium
  • Autoimmune encephalitis
  • Sheehan's syndrome
  • Autoimmune disorders
  • Substance use disorders
  • Medication-related adverse events

How is PPP investigated?

  • Labwork: metabolic panel, CBC, TSH, free T4, TPO antibodies
  • Urinalysis, urine toxicology screen
  • Brain imaging if neurological symptoms present

How is PPP treated?

PPP is considered a psychiatric emergency, requiring immediate hospitalization and treatment.

Benzodiazepines, antipsychotics, and lithium are implicated

Nursing Management

See nursing management for schizophrenia.

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.