Emotional change during pregnancy and the postpartum period is very common (37, 42); mental illness of psychotic proportions occurs more frequently in the postpartum period than in the period of pregnancy (33). These psychotic illnesses occurring in the postpartum period have remained an area of controversy for several reasons. The clinical phenomenology of these psychotic reactions seems unusually rich in confusional and delirious features (19), even when reported by those who contend they are no different from the usual run of psychotic illness (41). The fact that 80 per cent. of these serious reactions occur in the first 30 days postpartum (33) has raised doubt in the minds of some that these reactions merely represent the stress of pregnancy falling on a predisposed personality. An alternative hypothesis might be that the interaction of psychological and endocrine factors at the end of pregnancy makes this a particularly stressful period. The delirious and confusional symptoms might also be better explained as being related to endocrine dysfunction of some kind.

Pregnancy and the post-partum period are generally regarded as maturational crises equal in importance to those of adolescence and the menopause. Stresses undergone during this period include (a) endocrine changes, (b) activation of unconscious psychological conflicts pertaining to pregnancy and (c) the intrapsychic reorganization of becoming a mother. In light of this, it seems likely that clinically significant interactions of psychosocial and endocrine factors will be found in the aetiology of these disorders. The first month post-partum shows the greatest incidence of overt mental illness (7, 9), and this has led many to relate this disturbance to the termination of placental function and the metabolic and/or endocrine changes accompanying this.

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