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Postpartum or puerperal psychosis: causes, symptoms and treatment

Postpartum or puerperal psychosis: causes, symptoms and treatment

May 2, 2024

On rare occasions, symptoms of psychosis appear in women who are in the period immediately after delivery. Although psychiatric textbooks do not collect puerperal psychosis as a specific disorder, many professionals use this concept to refer to such situations.

In this article we will analyze the symptoms and the main causes of puerperal psychosis , as well as other of its basic characteristics. We will also briefly review the therapeutic options currently available to handle this problem.

  • Related article: "The 5 differences between psychosis and schizophrenia"

What is puerperal psychosis?

Puerperal or postpartum psychosis is a type of psychotic disorder that occurs in women who have just had a baby, usually in the two weeks after delivery. It is characterized by typical symptoms of psychosis such as hallucinations, delusions, disorganization of thought , behavioral disinhibition and catatonia.


In psychotic disorders there is a loss of contact with reality that can manifest itself in different areas and has a variable severity. It is believed that there is a strong genetic influence that determines the development of psychosis symptoms.

This form of psychosis was described by German obstetrician Friedrich Benjamin Osiander in 1797. In the past, puerperal psychosis was attributed to infections, thyroid disorders or eclampsia, a seizure disorder of pregnancy; Although these hypotheses have been ruled out (except for the thyroid), the causes remain unclear.

It is a relatively rare alteration, given that affects 1 in every 1000 women who give birth . In comparison, postpartum depression, a subtype of major depressive disorder, occurs in approximately 15% of mothers. Although psychotic symptoms may appear in the setting of postpartum depression, they are different disorders.


The DSM manuals do not include the diagnosis of puerperal psychosis; using these guidelines, these cases should be classified as "Psychotic disorders not specified". In the ICD-10 we find the category "Mental and behavioral disorders in the puerperium", which also includes postpartum depression.

  • Maybe you're interested: "Baby blues: sadness after childbirth"

Symptoms and usual signs

The referred symptoms and observable signs of puerperal psychosis vary greatly depending on the specific case, and even along the course of the disorder in the same person. Opposite symptoms, such as euphoria and the depressive state, sometimes occur together.

The most common early signs of postpartum psychosis they include the appearance of feelings of euphoria, the reduction in the amount of sleep, the mental confusion and the verbiage.


In addition to being classifiable in a psychotic type of picture similar to that of schizophrenia or schizoaffective disorder, the usual symptoms of puerperal psychosis are sometimes they also resemble those of mania and depression , the main alterations of mood.

  • Delusions and other strange beliefs
  • Hallucinations, especially of the auditory type
  • Paranoia and suspicion
  • Irritability and emotional instability
  • Low mood, even depressive
  • Mania: feeling of euphoria, increased energy and psychological agitation
  • Accelerated thinking and serious confusion
  • Difficulties for communication
  • Motor hyperactivity and behavioral disinhibition
  • Decreased need or ability to sleep
  • Lack of recognition of alterations
  • Increased risk of suicide and infanticide

Causes and risk factors

Research reveals that puerperal psychosis is associated with schizophrenia, bipolar disorder and schizoaffective ; About a third of women with these disorders suffer severe psychotic episodes after childbirth. In addition, people with postpartum psychosis have a 30% chance of having another episode in subsequent pregnancies.

It is believed that there is a genetic component to this disorder, since the fact that a close relative has been diagnosed with puerperal psychosis increases the risk of developing it by approximately 3%. The family history of depression in pregnancy or postpartum, psychotic-affective disorders and thyroid dysfunctions are also risk factors.

However, half of women who suffer from puerperal psychosis do not have any risk factor; a hypothesis that could explain this would be the one that associates this disorder with the hormonal changes and the sleep cycle that occur after childbirth . First-time mothers seem to have a greater chance of developing this type of psychosis.

  • Related article: "Schizoaffective disorder: causes, symptoms and treatment"

Treatment of postpartum psychosis

When a case of postpartum psychosis is detected, it is more usual for the hospital stay to be extended, or for the mother to be hospitalized again. In general, the management of this alteration is carried out through pharmacotherapy, although there are programs of psychological emergency intervention for psychosis that can be very useful as a complement.

Among the medications used to treat this alteration, two categories stand out: antipsychotics and mood stabilizers , reference psychopharmaceuticals in bipolar disorder. Antidepressants can also be useful for managing symptoms such as depressed mood, irritability, sleeping difficulties and cognitive problems.

Cases resistant to drug treatment that are also serious, such as those that carry a manifest risk of suicide, are sometimes treated with electroconvulsive therapy.

Most people who suffer this alteration recover completely after six months to a year, while the severity of symptoms usually decreases clearly before three months after delivery. The risk of suicide remains high during the recovery period .

  • Maybe you're interested: "Suicidal thoughts: causes, symptoms and therapy"

Postpartum Depression: What You Need to Know (May 2024).


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