Puerperal psychosis: a psychiatric emergency
Puerperal (postpartum) psychosis is a rare, severe mental illness after childbirth in which the mother loses touch with reality, and it is a medical emergency.
Remember
Puerperal psychosis is an emergency: it needs specialist assessment on the same day because of the high risk of harm to the mother and the infant, and the mother may not realise she is ill.
Puerperal psychosis is also called postpartum psychosis. Psychosis means losing touch with reality. The illness is rare, affecting around 1 in 1,000 mothers soon after birth. Symptoms usually start suddenly in the first 2 weeks after birth, often within hours or days of delivery, and sometimes later.
The picture can include hallucinations (hearing, seeing or feeling things that are not there), delusions (fixed false beliefs) or mania (an abnormally high, overactive state), or very low mood, sometimes with confusion. A typical picture also includes sleeplessness and rapidly changing mood.
It is a psychiatric emergency (an emergency involving mental illness) because it can get worse rapidly and carries a high risk of suicide and of harm to the baby, including infanticide (the killing of an infant). The mother may not realise she is ill, so partners, family or friends often have to spot the signs and act. A lack of earlier psychiatric illness does not make it any less urgent.
She needs an urgent assessment on the same day. Treatment is usually in hospital, ideally in a mother and baby unit (a specialist psychiatric unit where the baby can stay with the parent), and it can include antipsychotic medicine (medicine for the delusions and hallucinations). Most people make a full recovery with the right treatment.
Do not confuse it with the baby blues, which are common and mild, with tearfulness and mood swings, and usually go away within 2 weeks of birth. Nor is it postnatal depression, an illness of low mood and loss of enjoyment that can start any time up to a year after birth. The blues pass, depression needs treatment, and psychosis is an emergency.
Key facts
- Onset
- usually sudden, in the first 2 weeks after birth, often within hours or days of delivery
- How common
- rare, affecting around 1 in 1,000 mothers
- Features
- delusions, hallucinations, mania and/or low mood, sometimes with confusion
- Why urgent
- it can worsen rapidly and risks suicide and harm to the infant, and the mother may not realise she is ill
- Action
- urgent specialist assessment on the same day, with treatment usually in hospital, ideally a mother and baby unit
- Outlook
- most people make a full recovery with the right treatment
- Recurrence
- about a 1 in 2 chance of another episode after a future pregnancy
Exam traps
- A mild mood disturbance describes the baby blues, which are common, mild and usually go away within 2 weeks of birth. Puerperal psychosis is a serious illness that needs urgent assessment.
- Low mood and loss of enjoyment describe postnatal depression, which can start any time up to a year after birth. It is a serious illness, but psychosis is not its defining feature, whereas puerperal psychosis needs urgent specialist assessment, often with hospital admission.
- Post-traumatic stress disorder can follow a traumatic birth and brings distressing memories of the trauma, such as flashbacks and nightmares. It is a different diagnosis from puerperal psychosis, which centres on delusions, hallucinations or mania.
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