Emergent Care / Stabilization:
Postpartum psychosis is a medical emergency. Patients should be evaluated immediately and require inpatient hospitalization until stabilized. In addition, infants should not be left alone in the care of a parent with postpartum psychosis.

Diagnosis Overview:
Postpartum psychosis is characterized by the rapid onset of psychotic symptoms in the postpartum period. Both psychotic and mood symptoms typically develop 3-10 days after childbirth. These psychotic symptoms may include hallucinations, delusions, behavioral changes, confusion, disorganization, flight of ideas, and reckless behavior. Delusions may relate to the infant or the infant's care (in contrast to more bizarre delusions seen in schizophrenia). Patients also commonly show symptoms of a mood disorder, such as mania or depression, severe insomnia not related to the care of a newborn, anxiety, irritability, and agitation.

Postpartum psychosis affects maternal-infant bonding and can lead to abuse and neglect of the infant. In addition, these patients are at increased risk for suicide. Homicidal behavior is possible, although rare.

Postpartum psychosis is rare, affecting 1-2 per 1000 births, which is less common than postpartum depression. It is most commonly seen in women with a history of bipolar disorder, although it may also be seen in patients with schizophrenia or schizoaffective disorder. Other risk factors include personal or family history of postpartum psychosis, family history of bipolar disorder, primiparity, and discontinuation of psychiatric medications for pregnancy. 

Approximately 20%-50% of women diagnosed with postpartum psychosis will have a single episode limited to the postpartum period. In other cases, postpartum psychosis can be the first presentation of a more severe, lifelong bipolar mood disorder, and these women will have episodes outside of the peripartum period. The risk of recurrence for those with a history of postpartum psychosis is 31%. For those with a history of bipolar disorder and postpartum psychosis, the risk of recurrence is much higher, ranging from 41%-87%.