Treatment: Requires hospitalisation 🏥. Antipsychotics and/or antidepressants are often needed, sometimes alongside mood stabilisers or ECT. Postpartum psychosis is a psychiatric emergency.

📚 Background

Incidence: ~1 in 500–800 deliveries (rare but serious).
Onset: Typically begins 2–7 days postpartum, peaks by ~2 weeks.
Distinct from postpartum depression/anxiety → psychotic features present.
Rapid onset + high risk = medical emergency 🚨.

🧠 Diagnosis

Based on presence of psychotic symptoms:
- Delusions: Often about infant (health, identity, harm).
- Hallucinations: Voices or visions (e.g. commands to harm baby or self).
- Cognitive impairment: Disorganised thinking, poor concentration, confusion.
- Mood instability: Mania, depression, or mixed features.
Often preceded by severe insomnia + agitation ⚡ → early warning sign.

👩‍👦 Clinical Features

Unawareness of illness (due to psychosis).
Severe mood disturbance (manic and/or depressive).
Disordered thought content (bizarre or paranoid).
Profound insomnia 😵.
Inappropriate responses to baby.
Life-threatening risk for both mother and infant if untreated 🚨.

⚠️ Risk Factors

History of psychosis or bipolar disorder (esp. untreated).
Previous postpartum psychosis (high recurrence risk).
Primiparity 👶 (first-time mother).
Psychosocial stress: marital conflict, poor support.
Stopping psychiatric meds during pregnancy (esp. mood stabilisers).

🛠️ Management

Immediate hospitalisation: Ensure maternal + infant safety. 👉 Suicide risk ↑ 70-fold in first postpartum year.
Pharmacological:
- Antipsychotics for psychotic symptoms.
- Mood stabilisers (e.g. lithium, valproate, carbamazepine) – esp. bipolar disorder.
- Short-term sedatives (benzodiazepines) for insomnia/agitation.
ECT: Considered if high risk of harm or resistant to meds.
Close monitoring needed: early-onset psychosis (within 1 month) responds better to rapid treatment.
In schizophrenia: recurrence risk postpartum = 30–50% 🔄.
Long-term care: Psychiatric follow-up, relapse prevention, support for parenting.

📊 Teaching Table

Feature	Postpartum Psychosis	Postpartum Depression
Onset	Days to weeks after birth (often < 2 weeks)	Usually 4–6 weeks postpartum
Core symptoms	Delusions, hallucinations, disorganised thought, mood swings	Low mood, fatigue, guilt, bonding difficulties
Risk	High risk of suicide/infanticide	Risk present but lower
Management	Hospitalisation + antipsychotics ± mood stabiliser ± ECT	Community-based: SSRIs, CBT, family support

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Postpartum / Postnatal Psychosis