Alerts and Notices
SynopsisPostpartum psychosis is characterized by the rapid onset of psychotic symptoms in the postpartum period. These psychotic symptoms may include hallucinations, delusions, behavioral changes, confusion, and disorganization. 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, insomnia not related to the care of a newborn, mood changes, anxiety, irritability, and agitation.
Both psychotic and mood symptoms typically develop within 2 weeks of childbirth. These patients are at increased risk for suicide. Homicidal behavior is possible, although rare.
The condition occurs in 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, first pregnancy, and discontinuation of psychiatric medications for pregnancy. Women are at high risk of recurrence of the condition with subsequent pregnancies.
F53.1 – Puerperal psychosis
18260003 – Postpartum psychosis
Differential Diagnosis & Pitfalls
- Bipolar disorder
- Schizoaffective disorder
- Major depression with psychotic features
- Substance use disorders (see, eg, alcohol use disorder, benzodiazepine use disorder, cocaine use disorder, methamphetamine use disorder, opioid use disorder)
- Infectious diseases such as mastitis, endometritis, and cellulitis
- Metabolic encephalopathy or delirium
- Thyroid disease (see, eg, thyroiditis)
- Postpartum angiopathy
- Cerebral venous thrombosis