Early Postpartum Symptoms in Puerperal Psychosis

Childbirth is frequently an occasion for the onset of psychiatric symptoms, especially in women who are vulnerable to bipolar disorders. Women with puerperal psychosis (PP), the most severe form of postnatal psychiatric illness, are more than 20 times likelier to have the onset of a manic or psychotic episode in the first postpartum month than at any other time in their lives. This retrospective interview study enrolled 127 women who developed bipolar affective PP—strictly defined—within 4 weeks after childbirth. Semistructured interviews were based on the Schedule for Clinical Assessment in Neuropsychiatry, or SCAN). Mania, depression, and psychosis were estimated by a SCAN-trained psychiatrist or psychologist. The mean age at the time of the interview was 40 years, and the median time from the first episode of PP to the interview was 9 years.

A single episode of PP was reported by 70% of the women interviewed. Although individuals with a clear onset of episodes during pregnancy were excluded, 10 women (8% of those interviewed) had experienced mild symptoms in the last few days before childbirth or had noted increasingly intense symptoms over the last trimester. In 51 others (40%), symptoms began on the day of delivery. Nearly three-fourths of women had developed symptoms within 3 days after childbirth. Among the most frequently described symptoms reported by 4 or more women within 3 days of childbirth were feeling excited or elated (52%), not needing (or being able to) sleep (48%), feeling active or energetic (37%), and talking more or feeling “chatty” (31%). Other commonly reported early symptoms included confusion, irritability, anxiety, detachment, and lability.

Recognition of potential prodromal signs of PP in postnatal women, along with monitoring of mental status in women at risk, might prevent some psychiatric-related deaths. Hypomanic symptoms in the early postpartum period are characteristic of women who go on to develop PP.