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 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.

Therapy can help you manage your mental health during pregnancy

Connect with a licensed therapist online

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.