Co-Director Kathryn Emerick, MD
photo: Jamie Manser
Postpartum psychosis (PPP) is a rare but severe psychiatric illness that affects approximately 1–2 per 1,000 births in the general birthing population, most often — although not exclusively — emerging within the first two weeks after delivery. The strongest risk factors include a personal or family history of bipolar disorder, a personal or family history of postpartum psychosis, and discontinuation of mood-stabilizing medication during pregnancy in individuals with bipolar disorder. Symptoms of PPP can develop rapidly and have characteristics of both delirium and a bipolar mood episode (not just mania but also depression, or mixed episodes). Unlike other PMADs, postpartum psychosis can include symptoms of confusion and disorientation, making these symptoms critically important to assess. Moms struggling with PPP can also fluctuate between periods of mild symptoms and severe psychiatric symptoms. This waxing and waning course makes it essential to speak to family members or support people during assessment.
PPP is a psychiatric emergency that requires immediate psychiatric evaluation and, in most cases, hospitalization to ensure the safety of both the parent and infant. Without prompt treatment, the illness carries significant risk of death, including suicide, which occurs in approximately 5% of untreated cases, and infanticide, reported in approximately 4% of untreated cases. Beyond these tragic outcomes, the altered consciousness, impaired orientation, cognitive disturbances, and psychotic symptoms characteristic of postpartum psychosis can significantly impair an individual's ability to safely care for a newborn, placing infants at risk of unintentional neglect or harm. Early recognition and rapid intervention- including prompt, complete psychiatric assessment, treatment with antipsychotic and/or mood-stabilizing medications, and coordinated support for the family can be lifesaving for both parent and baby.
While there is no screening tool for PPP and it is not recognized as a distinct illness in the DSM-V, MGH Center for Women’s Health recently released an excellent summary of the complexity and nuance of postpartum psychosis for those wishing to learn more about assessment.