Pregnancy Psychosis: Prevalence, Symptoms, And Treatment
Childbirth can be a significant stressor for many women, affecting their mental health and overall well-being. The unique challenges and demands that can arise during and after pregnancy may precipitate the onset of mental illness and even psychosis, or a break from reality. While psychosis can affect anyone, this condition may pose particularly significant risks for a pregnant person and their child. Speaking to your doctor or a mental health professional if you experience any concerning mental health symptoms during pregnancy may be helpful.
What is postpartum psychosis?
According to the National Institute of Health, childbirth can be "considered a major physical, emotional, and social stressor in a woman’s life." Many women experience mood disturbances that affect their postpartum mental health, and some develop psychiatric disorders and psychosis, which may be attributed to "bio-psycho-social factors."
Physical and hormonal changes, a lack of adequate sleep, and added responsibilities can be challenging for those navigating their newfound roles. Postpartum or puerperal psychosis, which can be considered one of the most severe mental illnesses during this stage of life, may affect one to two women out of 1000. This condition usually occurs within the first six weeks of childbirth and often within two weeks of childbirth.
Postpartum psychosis may involve the following psychotic features and symptoms:
- Extreme confusion
- Mania (extremely elevated mood)
- Altered perception of reality
- Paranoia
- Delusions
- Disorganized thinking
- Hallucinations
Puerperal psychosis may have a sudden onset, which can be frightening for those who experience the condition, as well as their partners and loved ones. However, with proper care, full recovery can be possible.
The prevalence of pregnancy psychosis
Findings indicate that pregnancy psychosis can arise during pregnancy or may be a manifestation of a previous psychiatric illness. According to research, the prevalence of psychotic episodes or pregnancy psychosis in the overall population is 4.6 per 1000 people, whereas postpartum psychosis may affect between one and two out of 1000 women.
Other studies suggest that the number may be closer to three out of 1000 women.
Having a psychotic episode during pregnancy tends to be associated with an increased chance of having more episodes in the future, especially during puerperium, the six-week period after childbirth. Some pregnant women may also experience the sudden onset of a psychiatric illness. As psychotic episodes may affect both the mother and the fetus, any potential psychotic symptoms typically require the immediate attention of mental and medical health specialists during and after pregnancy.
Risk factors for postpartum psychosis
Some factors may raise the risk of developing postpartum psychosis. These factors generally include one's family history, genetic predisposition, neurotransmitter dysregulation, and previous experience of postpartum psychosis. Having a close relative who has experienced postpartum psychosis tends to be associated with a higher risk of experiencing the condition.
Sleep disturbances and accompanying exhaustion, as well as hormonal changes, may also increase one's risk. Those who have previously been diagnosed with bipolar disorder (especially bipolar type I) and schizoaffective disorder may also be more likely to experience postpartum psychosis.
However, psychosis can also affect people with no history of mental illness or psychotic episodes.
Concerns regarding psychosis to address with a professional
If you are at risk for developing psychosis, discussing your concerns with your general practitioner, obstetrician or midwife, and a mental health professional, such as a perinatal psychiatrist or mental health nurse, may be beneficial.
A specialist may help you address concerns regarding:
- Your risk of developing psychosis
- The potential benefits and risks of taking psychotropic medication during and after pregnancy
- Coordinating efforts for further care
Pre-birth planning is usually recommended to ensure that everyone involved in your care can offer the appropriate assistance. After giving birth, you can monitor your health and well-being to catch concerns early on. If you experience a psychotic episode, you may need to seek urgent care.
The effects of postpartum psychosis, depression, and related condition
Adverse pregnancy outcomes
Findings suggest that women who are experiencing a psychotic episode during delivery may have a higher risk for cesarean delivery, induced labor, antepartum hemorrhage, placental abruption, postpartum hemorrhage, premature delivery, stillbirth, fetal abnormalities, and fetal distress.
Other research suggests that "a combination of socioeconomic, behavioral, genetic factors and comorbid medical conditions, and environmental factors may explain the higher risk of adverse obstetric and neonatal outcomes among women with psychosis."
Additional factors, such as lack of social support, vitamin D deficiency, and behaviors like smoking and substance misuse, may further pose a risk of adverse outcomes in pregnant women with psychosis.
Stress and psychotic symptoms
Stress can trigger symptoms of psychosis, and studies suggest that high stress levels tend to be associated with increased psychotic symptoms in both clinical and non-clinical populations.
Mental health care for psychotic symptoms
In general, treatment for psychosis involves a combination of talk therapy, prescription antipsychotic medication, and various psychosocial interventions.
In relation to pregnancy, treatment for psychosis may be more complex, taking into consideration "prior diagnosis or new onset of a mental illness, medication previously used, trimester of pregnancy and risk of teratogenicity."
The use of antipsychotic medication, however, may be linked to an increase in neonatal toxicity. Due to this and other possible risks, experts suggest that recommendations be based on "evaluating the suspension of treatment if the underlying disease presents minimal symptoms or using the minimum possible dose," and informing the patient and their care team of the situation. Mental health specialists may address the risk of psychotic episodes on a case-by-case basis, assessing the benefit/risk ratio for each individual.
People seeking alternative treatments to medication may be interested in pursuing therapy, and those who are taking antipsychotic medications may still benefit from therapy as a supplemental treatment. Cognitive behavioral therapy (CBT) is one evidence-based treatment approach specifically geared toward examining the way one thinks and behaves and finding healthy ways to cope with symptoms of many mental health concerns, including psychosis.
Addressing pregnancy-related challenges in online therapy
If you are at risk for developing psychosis or are experiencing psychotic symptoms, seek out a psychiatric evaluation for diagnosis and treatment. Seeing a therapist can also be helpful for finding ways to manage symptoms and mitigate stress, such as through mindfulness meditation. However, some people may face barriers to treatment such as cost or location.
The benefits of online therapy
Online therapy through platforms like BetterHelp can be convenient for many people, allowing you to attend sessions with a licensed therapist from the comfort of your own home. You can speak to a mental health professional by phone, video, or online chat. Many therapists on the platform specialize in cognitive behavioral therapy, an approach that can be helpful for managing symptoms of psychosis. However, those currently experiencing acute symptoms may require in-person care.
What the research says about online therapy’s efficacy
One study suggested that "online interventions are both feasible and acceptable to individuals with psychotic disorders and may be effective in assisting with clinical and social outcomes." The same study noted that online therapy is typically associated with reduced psychotic symptoms.
Takeaway
Questions to ask your therapist about schizophrenia, bipolar disorder, and other causes of postpartum psychosis
How common is pregnancy psychosis?
One study suggests that postpartum psychosis may affect up to three out of 1000 women. Another systematic review lists the prevalence of perinatal psychosis to be between 0.89 and 2.6 out of 1000 women. Other findings claim the number is closer to four in 1000 women. While psychosis may be relatively rare in the perinatal period and postpartum period, it's recommended that women showing signs of psychosis be closely monitored to safeguard their well-being and that of their child. Many women visit the local hospital emergency department to seek treatment or are taken there by a concerned family member who views it a mental health crisis. To have postpartum psychosis treated, it's helpful to contact a mental health provider who can refer them to specialist care.
What is schizophrenia, and is it the most common psychotic disorder?
The National Institute of Mental Health describes schizophrenia as a serious mental illness affecting a person's thoughts, feelings, and behaviors. Schizophrenia is considered the most common psychotic disorder within the range of schizophrenia spectrum disorders. When a person's condition is active, they may experience the following symptoms:
- Delusions (false beliefs about the nature of reality)
- Hallucinations
- Disorganized speech
- Loss of motivation
- Challenges with thinking
Am I at risk of postpartum psychosis if I have a history of bipolar disorder?
Pregnancy and childbirth are associated with precipitating mood disorders in many women, such as perinatal depression and in more severe cases, postpartum psychosis. Findings indicate that having bipolar disorder may increase the risk of developing postpartum psychosis. However, many other factors contribute to the risk of developing psychosis during or after pregnancy, a time of rapid hormonal changes. These factors may include:
- Experiencing physical stress
- Severe sleep deprivation or having a sleep disorder
- Personal or family history of mental health conditions
- Substance misuse (what may sometimes be referred to as substance abuse)
- Sensitivity to rapid hormonal changes
- A past history of trauma, especially during childhood
- Having gestational diabetes
What mental health disorders are risk factors for postpartum psychosis?
Some mental health conditions may place some women at a higher risk for developing postpartum psychosis. These conditions include bipolar disorder (formerly known as manic depression) and depression. For example, studies indicate that around 20% of women with bipolar disorder may experience severe postnatal mental health challenges.
Can pregnancy contribute to a mental illness like bipolar disorder or depression?
Findings indicate that many women experience a high risk of developing a mental health condition during pregnancy. These conditions include anxiety with panic attacks, depression, and bipolar disorder. Postnatal depression, for example, is especially common, affecting around one in seven women after childbirth. Factors such as hormonal changes, stress, gestational diabetes, and less sleep may contribute to the development of these conditions.
What are the most common perinatal psychiatric disorders?
The most common mental health conditions associated with the perinatal period include depression and anxiety. Unlike temporary mood changes associated with the "baby blues" which tend to subside after a few weeks, postpartum depression (PPD) can last for months if unaddressed. While symptoms can range from mild to severe, women with PPD whose symptoms begin within the first eight weeks of childbirth tend to experience more severe depression symptoms.
What causes delusions during pregnancy?
Postpartum psychosis (PPP) refers to a condition that may cause delusions, hallucinations, and severe mood swings in a small percentage of women. These symptoms tend to occur within the first few weeks postpartum, often between three and ten days of childbirth. Studies show that having a history of childhood trauma, as well as experiencing trouble sleeping and a rapid decline in estrogen following childbirth may prompt the onset of symptoms of PPP in some women.
What is pregnant psychosis?
Postpartum psychosis is considered a serious mental health condition affecting some women after childbirth. It's recommended to immediately seek medical help to have postpartum psychosis diagnosed (if applicable) and receive the right treatment. The clinical management of postpartum psychosis usually involves psychotherapy, medication in the acute phase of the condition, and in some cases, electroconvulsive therapy. In The United Kingdom, women may be referred to the mother and baby unit for specialized care.
How to prevent pregnancy psychosis?
Specific treatment varies according to the risk factors of each person. However, findings suggest that women who may be considered at risk can benefit from sleeping for an adequate amount and not receive too many visitors immediately after the postpartum period. Antipsychotic medication and mood stabilizers may also be recommended.
What are the red flags of postpartum psychosis?
Postpartum psychosis (PPP) usually occurs within the first two weeks of childbirth. Symptoms can include hallucinations, delusions, periods of feeling unusually energetic (mania) and periods of low mood (depression), rapidly changing moods, and confusion. Since symptoms can worsen rapidly, PPP is usually considered a medical emergency, so it's recommended to contact a mental health provider or doctor for an evaluation. Effective treatment options for PPP may involve psychotherapy (talk therapy), mood stabilizers or antipsychotic medications, or electroconvulsive therapy in more severe cases, which present a higher risk of self-harm and aggressive behavior.
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