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Postpartum Psychosis

The symptoms of Postpartum Psychosis may appear very similar to those of other psychotic disorders (see above) but they are usually unexpected and develop very rapidly, within hours. They most often appear within 72 hours to four weeks after the baby is born.   The episode lasts at least a day and may last up to one month with eventual return to the woman’s previous level of functioning.  Immediate treatment is required for the safety of the woman and her baby.

Women at increased risk for Postpartum Psychosis include those:

  • with a personal history of psychosis in previous pregnancies
  • with Bipolar Disorder
  • with a family history (close relative) of Postpartum Psychosis
  • with a family history (close relative) of Bipolar Disorder or Schizophrenia
  • who may have substance dependence issues

In rare cases, women with no previous history will develop a postpartum psychosis.   As well as appropriate care during the current pregnancy or postpartum period, specifically focused care during subsequent pregnancies should be offered as the woman has a more than 50% risk of reoccurrence in subsequent pregnancies.

As with other psychotic disorders, intensive and immediate help will be required when the woman develops psychotic symptoms.  Postpartum psychosis is a psychiatric and obstetrical emergency. 

Particular care should be taken where distorted thoughts or behaviours involve the baby. There is a risk (although a small one) of maternal suicide or infanticide. Women who present with acute symptoms of a postpartum psychosis usually have little insight into the seriousness of their condition. They will require hospitalization for their safety, for their baby’s safety and to start treatment with medications.

Once the acute symptoms are responding to treatment, the risks and impacts of Postpartum Psychosis can be successfully managed. Postpartum psychosis is primarily managed with medication but sometimes, ECT (Electro Convulsive Therapy) may be suggested as an alternative if the woman is unable to tolerate or take the medications for example. It is also helpful to include non-pharmacological treatments.  (See the section on Treatment)  The support of family and friends for the woman and her baby will be very important. 

If you are concerned about the Signs and Symptoms in any woman you are caring for during pregnancy or postpartum, immediate help is needed.  Talk urgently to your family physician or take the woman to the Emergency Department of the nearest hospital.