Psych · General adult psychiatry — perinatal
Postpartum psychosis
Also known as Puerperal psychosis · Postnatal psychosis · Postpartum mania · Peripartum psychosis · Childbirth-related psychosis
Exam-exhaustive fellowship reference on postpartum psychosis — onset timing, bipolar spectrum link, dual mother-infant risk, organic differential, admission and mother-baby units, Bergink-informed lithium/antipsychotic/benzodiazepine algorithms, ECT, lactation decisions, recurrence and prevention in subsequent pregnancies. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- New mania, mixed state, or psychosis within days to weeks after birth — psychiatric emergency; same-day senior review and secure setting
- Ego-syntonic delusions or command hallucinations involving the infant — treat on psychosis pathway with continuous infant-safety plan
- Maternal suicidal intent or plan in florid PPP — escalate observation and setting immediately
- Inability to care for the infant safely, neglect risk, or filicide ideation with intent — multi-agency safeguarding plus treatment
- Severe insomnia from day 1–14 postpartum with behavioural change — do not dismiss as 'normal new-parent exhaustion'
- Known bipolar or prior PPP presenting in late pregnancy or early puerperium after stopping prophylaxis — extreme relapse risk
Meet the patient
Day five. First baby, uncomplicated delivery, home at 48 hours. Tonight her partner rings the ward: she has not slept for three nights, she is talking faster than he can follow, and she has said twice that the baby in the cot is not theirs.[1][5]
She is 29 with no psychiatric history. Her mother "had a breakdown" after her second child. On the phone she sounds bright, fluent and entirely certain.[1][6]
The examiner will not ask you for the diagnosis. The examiner asks: what happens in the next hour, and who is unsafe while you decide?[1][2]
References16ShowHide
- [1]Bergink V, Rasgon N, Wisner KL Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood Am J Psychiatry, 2016.PMID 27609245
- [2]Bergink V, Burgerhout KM, Koorengevel KM, Kamperman AM, Hoogendijk WJ, Lambregtse-van den Berg MP, et al. Treatment of psychosis and mania in the postpartum period Am J Psychiatry, 2015.PMID 25640930
- [3]Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis Am J Psychiatry, 2016.PMID 26514657
- [4]Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA Prevention of postpartum psychosis and mania in women at high risk Am J Psychiatry, 2012.PMID 22407083
- [5]Jones I, Chandra PS, Dazzan P, Howard LM Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period Lancet, 2014.PMID 25455249
- [6]Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB New parents and mental disorders: a population-based register study JAMA, 2006.PMID 17148723
- [7]Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391
- [8]UK ECT Review Group Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis Lancet, 2003.PMID 12642045
- [9]Patorno E, Huybrechts KF, Hernandez-Diaz S Lithium Use in Pregnancy and the Risk of Cardiac Malformations N Engl J Med, 2017.PMID 28854098
- [10]Galbally M, Sved-Williams A, Kristianopulos D, Mercuri K, Brown P, Buist A Comparison of public mother-baby psychiatric units in Australia: similarities, strengths and recommendations Australas Psychiatry, 2019.PMID 30407072
- [11]Chesney E, Goodwin GM, Fazel S Risks of all-cause and suicide mortality in mental disorders: a meta-review World Psychiatry, 2014.PMID 24890068
- [12]Gilden J, Kamperman AM, Munk-Olsen T, Hoogendijk WJG, Kushner SA, Bergink V Long-Term Outcomes of Postpartum Psychosis: A Systematic Review and Meta-Analysis J Clin Psychiatry, 2020.PMID 32160423
- [13]Jairaj C, Seneviratne G, Bergink V, Sommer IEC, Dazzan P Postpartum psychosis: A proposed treatment algorithm J Psychopharmacol, 2023.PMID 37515460
- [14]Rommel AS, Molenaar NM, Gilden J, Kushner SA, Westerbeek NJ, Kamperman AM, et al. Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women Int J Bipolar Disord, 2021.PMID 34708260
- [15]Speisman BB, Storch EA, Abramowitz JS Postpartum obsessive-compulsive disorder J Obstet Gynecol Neonatal Nurs, 2011.PMID 22092284
- [16]Kellner CH Electroconvulsive Therapy (ECT) for Postpartum Psychosis: Treatment for a Medical Emergency Am J Psychiatry, 2025.PMID 41320827