Introduction 

Postpartum psychosis is a mental health disorder in which the parent, assigned female at birth (AFAB), experiences confusion, hallucinations, delusions, and episodes of high mood followed by depression. It is considered a psychiatric emergency and needs urgent management as it can result in suicide or infanticide. 

Its symptoms can start developing days to weeks after the baby's birth. It proves to be a difficult time for the person, the partner, and the family as full recovery may take a few weeks.¹ However, the incidence of postpartum psychosis is 1 in 1000 postpartum persons assigned female at birth (AFAB), which is much less than baby blues and postpartum depression. 

Postpartum psychosis and other conditions

It is defined as a new occurrence of the following symptoms – mania and depression, psychosis without mood symptoms, starting within 6 weeks of childbirth. The symptoms can vary from person to person, however, one of the hallmark features of this disorder is delusions – which means the person has a firm belief in something that does not exist and can not distinguish unreal from real.^1,2 

Postpartum blues is also a condition that usually starts 3-4 days after birth in which a person faces mood swings, anxiety, and tearfulness, but it stops by the time the baby is 10 days old. It is quite common as it affects more than half of new mothers. Postpartum depression is another condition characterised by feelings of low mood, reduced self-esteem, anxiety, and mood swings. It can last up to 6 months after childbirth and affects 10-15 out of 100 persons AFAB after childbirth. 

Risk factors of postpartum psychosis

Different factors can increase the risk of developing this disorder. The highest risk of up to 50% is found in people who have a history of postpartum psychosis in previous pregnancies or have a mental health history of bipolar disorder type 1 and schizoaffective disorder. 

Family history of this disorder is also one of the risk factors along with being pregnant for the first time. Additionally, social factors like lack of support, lack of sleep, financial difficulties, a difficult pregnancy or childbirth experience, and hormonal fluctuations can further exacerbate the risk.^3,8

Delusions in postpartum psychosis

Women experiencing postpartum psychosis may develop unfounded beliefs that can profoundly affect their perceptions of reality. For instance, they may experience delusions of persecution, feeling as though someone is plotting to harm them or their newborn. Additionally, some may harbour beliefs that their baby is inherently evil or seriously unwell, or even that the infant is not their own child. 

On the other hand, AFAB people might also develop grandiose delusions, attributing extraordinary abilities to their baby or themselves. These delusions can sometimes take on a religious tone, with affected women believing that their actions align with divine will.

It's crucial to note that these delusional beliefs are entirely detached from reality and may pose risks to both the person and the child if one acts upon them. For instance, a person influenced by delusions may neglect the baby's needs or engage in behaviours that jeopardise their safety. Therefore, recognising and addressing these delusions promptly is essential to ensuring the well-being of both the parent and child.^4,6

Diagnosis 

To confirm the diagnosis, several tests need to be done to rule out any infection, metabolic, or endocrine abnormality.¹ These tests may include:

• A complete blood count (CBC)
• Electrolytes
• Blood urea nitrogen (BUN)
• Blood glucose
• Creatinine
• Vitamin B12
• Folate
• Thiamine
• Calcium
• Thyroid function tests
• Liver function tests 
• Urinalysis
• Urine/blood cultures for patients with fever
• CT/ MRI brain 

Treatment

The treatment for this disorder involves in-patient assessment and care. The treatment of choice is the pharmacological treatment, in which antipsychotics, antiepileptics, and mood stabilisers are given. Lithium is given as the drug of choice unless contraindicated along with therapy and cognitive behavioural therapy. However, in severe cases therapy, electroconvulsive therapy is also recommended. The treatment is successful in most cases, but it is important to pick up the signs and get help.^1,7

Impact on mother and family

The impact of postpartum psychosis extends beyond the individual affected to their entire family. Persons experiencing postpartum psychosis may feel overwhelmed, frightened, and disconnected from reality. 

Delusions can strain relationships with partners, family members, and healthcare providers, leading to feelings of isolation and shame. Additionally, the well-being of the infant may be compromised if not provided with adequate care.⁵

Prevention and support

While it may not be possible to prevent postpartum psychosis entirely, certain strategies can help mitigate the risk. Lithium can also be given as prophylaxis. If you are at risk of developing psychosis then your health care provider will get you referred to perinatal mental health services.⁷ 

Moreover, having a strong support network of family, friends, and healthcare professionals can provide crucial assistance and reassurance during the postpartum period. For those affected by postpartum psychosis, accessing appropriate treatment and support services is vital for recovery and maintaining well-being. Many support groups can be joined which prove to be very helpful.^1,8 

FAQs 

What is postpartum psychosis?

Postpartum psychosis is a severe mental health condition that can occur in the weeks following childbirth. It is characterised by a rapid onset of symptoms such as hallucinations, delusions, mood swings, confusion, and disorganised thinking.

What are delusions in the context of postpartum psychosis?

Delusions are false beliefs that are firmly held despite evidence to the contrary. In postpartum psychosis, delusions often revolve around themes related to the baby, parenthood, or personal identity. For example, affected individuals may believe that their baby is possessed, that they are being persecuted, or that they have special powers.

How common is postpartum psychosis?

Postpartum psychosis is relatively rare, occurring in approximately 1 to 2 out of every 1,000 persons AFAB who give birth. However, it is considered a psychiatric emergency due to its potential severity and the risks it poses to both the affected individual and their family.

What are the risk factors for postpartum psychosis?

Several factors can increase the risk of developing postpartum psychosis, including biological factors such as hormonal fluctuations and genetic predisposition, psychological factors such as stress or trauma, and social factors such as lack of support or financial difficulties. Persons AFAB with a personal or family history of bipolar disorder or schizophrenia are also at higher risk.

How are postpartum psychosis and postpartum depression different?

While postpartum psychosis and postpartum depression are both mood disorders that can occur after childbirth, they differ in terms of severity and symptoms. Postpartum depression typically involves feelings of sadness, anxiety, and low energy, whereas postpartum psychosis is characterised by more severe symptoms such as hallucinations and delusions.

Can postpartum psychosis be treated?

Yes, postpartum psychosis can be treated with a combination of medication, such as antipsychotic drugs, and therapy, including cognitive-behavioural therapy or supportive counselling. In severe cases, hospitalisation may be necessary to ensure the safety of both the person and the baby.

What is the impact of postpartum psychosis on the person and the family?

Postpartum psychosis can have profound effects on mental health, leading to feelings of confusion, fear, and disconnection from reality. Delusions, in particular, can strain relationships with partners, family members, and healthcare providers. Additionally, the well-being of the infant may be compromised due to inadequate care.

How can postpartum psychosis and delusions be prevented?

While it may not be possible to prevent postpartum psychosis entirely, certain strategies can help mitigate the risk. These include accessing prenatal care, screening for mental health disorders, building a strong support network, and providing education about postpartum mood disorders. Early detection and intervention are also essential for ensuring prompt treatment and support.

Summary 

Postpartum psychosis is a serious mental health condition that requires careful attention and support. Delusions, as one of its defining features, can profoundly impact the lives of affected individuals and their families. By increasing awareness, promoting early detection, and providing comprehensive treatment and support, we can help ensure the well-being of the person experiencing it and their families during the postpartum period.