Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

Abstract

Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.

Steroid-responsive encephalopathy associated with autoimmune thyroiditis presenting with a postpartum psychosis

“…A recent meta-analysis estimates that one in five women with bipolar disorder is affected by psychotic or mood episodes in postnatal period. Longitudinal research suggests an association between psychosis in the postpartum period and onset of bipolar disorder, particularly if hospitalisation is required 12…”

“…Patients may have mood lability, confusion and marked cognitive impairment, similarly to delirium. Bizarre behaviour, insomnia, hallucinations and delusions are frequent 11 12. Delusions are often persecutory and referential, often involving the child 6.…”

Traumatic xylophagia leading to foreign body removal and tracheostomy in the setting of postpartum psychosis

“…PPP has an incidence of 0.1–0.2% in postpartum patients, with proposed mechanisms including hormonal changes, circadian rhythm disruption and immunologic and genetic factors [ 1 ]. Symptoms may include depression and anxiety, but disorganized thought, delusions, mania or hallucinations distinguish PPP from the postpartum blues [ 2 ].…”

“…Postpartum psychosis (PPP) is defined as severe mood disturbance following childbirth, possibly with severe and injurious behavior [ 1 ]. Hospitalization expedites treatment and ensures patient safety, as cases of suicide and filicide have been reported [ 2 ].…”

Burden of severe maternal peripartum mental disorders in low- and middle-income countries: a systematic review

“…Prevalence studies of PSMDs have predominantly focussed on the postpartum period rather than pregnancy (Jones et al 2014). The prevalence of postpartum psychosis is consistently estimated to be 1-2 per 1000 women who have recently given birth (Kendell et al 1987;Perry et al 2021). Establishing the true incidence and prevalence of an uncommon condition like postpartum psychosis is difficult, considering the relative rarity of the condition and the methodological challenges including need for assessment of very large samples and the logistical difficulties and costs associated with adequately sized prospective cohort studies.…”