What Clinicians Need to Know About Postpartum Psychosis

The recent, controversial trial of Lindsay Clancy renewed public attention on women's peripartum mental health. In this video, Mina Mirhom, MD, FAPA, a board-certified psychiatrist and Psychiatric Times section editor, outlined the most important fact about postpartum psychosis and 2 clinical points that are often missed.

A Medical Emergency

"Postpartum psychosis is a medical emergency happening in about 2 in every 1000 births," said Mirhom. Because the condition threatens the lives of both mother and infant, clinicians should treat it as urgent from the start. Published estimates put the incidence at 1 to 2 per 1000 deliveries, and onset usually comes within the first weeks after childbirth.¹

A Heterogeneous Presentation

Mirhom pushed back on the idea, common in online discussion of the case, that "psychosis is psychosis" whatever the cause. Postpartum psychosis often looks different from other psychotic illnesses. Some patients have delirium-like features such as confusion and disorientation. Others swing between periods of lucidity and florid psychosis.¹ Insomnia that does not respond to the usual treatments can also be part of the picture.

"It can present very differently from the way that we would typically see psychosis," Mirhom said. He advised keeping this variability in mind when evaluating a mother who is struggling in the postpartum period.

Recurrence Risk

Mirhom also stressed the risk of recurrence. Women with a history of postpartum psychosis have a much higher risk of relapse after later deliveries, and so do women with bipolar disorder.² Clinicians should take a thorough personal and family psychiatric history, including any prior postpartum psychosis or postpartum depression, when assessing risk and planning care.

Dr Mirhom is past president of the New York County Psychiatric Society, an assistant professor of psychiatry at Columbia University, a Forbes contributor, and chief wellbeing officer at Athletes for Hope.

References

1. Bergink V, Rasgon N, Wisner KL. Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry. 2016;173(12):1179-1188.

2. Wesseloo R, Kamperman AM, Munk-Olsen T, et al. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am J Psychiatry. 2016;173(2):117-127.