AKT · Psychiatry/Psychotic

Postpartum psychosis

Overview

A psychiatric EMERGENCY of rapid-onset psychosis (mania, delusions, hallucinations, confusion) typically within the first 2 weeks postpartum. ~1–2/1000 births; higher with bipolar/previous PP psychosis.

Recognise

Rapid onset days 1–14: mania or depression with psychosis, confusion, perplexity
Fluctuating, rapidly changing mental state
Risk to mother and infant

Red flags

ALL cases are emergencies — risk of suicide and infanticide; admit, ideally to a Mother and Baby Unit

Differentials & how to tell them apart

Postpartum depressionno psychosis, slower onset

Delirium (sepsis, eclampsia)organic cause, clouded consciousness — must exclude

Baby bluesmild, transient, no psychosis

Investigations

Urgent psychiatric assessment. Exclude organic causes (infection, eclampsia, thyroid, intracranial). Bloods, infection screen.

Management

1EMERGENCY: urgent admission, ideally to a Mother and Baby Unit (keep mother and infant together where safe).
2Antipsychotic ± lithium; ECT for severe or treatment-resistant illness.

Antipsychotic — acute treatment

Lithium — effective; affects breastfeeding decisions

ECT — for severe/refractory cases

Key points

High recurrence in future pregnancies — perinatal mental-health planning. Strong link with bipolar disorder.

Monitor & prognosis

Mother and infant safety; mental state (rapidly changing); medication.

Good recovery with prompt treatment, but high recurrence risk.

Source: NICE NG192; RCPsych