Postpartum psychosis

Postpartum psychosis is a rare but dangerous condition, associated with significant risk of suicide and infanticide—it is a psychiatric emergency. Symptoms are acute and include agitation, confusion, disorganised thoughts, sleep disturbance, hallucinations, delusions and abnormal mood. Risk factors include a previous episode of postpartum psychosis and a history of bipolar disorder (including a family history). A first episode of postpartum psychosis can evolve into bipolar disorder.

Postpartum psychosis should be treated by a psychiatrist in a specialised centre. Typically, an antipsychotic is used, although in complex cases, lithium and/or electroconvulsive therapy (ECT) may be required.

For advice on psychotropic use in breastfeeding, see here.

Patients who have had an episode of postpartum psychosis are at increased risk of further episodes in subsequent pregnancies. Once they have recovered from psychosis, discuss this risk with them; see Preventing postpartum psychosis.