What Is Postpartum Psychosis, And How Can You Find Support?
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Psychosis can be seen as a severe emotional state involving a cluster of symptoms that can lead to a mental health crisis. When in psychosis, an individual might experience hallucinations, delusions, and disorganized thoughts that indicate a disconnect from reality.
There can be various causes for psychosis, and each person may have a different experience. Some gestational parents experience psychosis during or after pregnancy, and this is typically referred to as postpartum psychosis. Understanding the unique symptoms of this condition may help individuals identify psychosis in themselves and others and promptly seek professional support.
What is postpartum psychosis?
In a study published in StatPearls, postpartum psychosis is defined as “extreme confusion, loss of touch with reality, paranoia, delusions, disorganized thought process, and hallucinations.” The study reports that psychosis impacts approximately one to two women of childbearing age per 1000. Anyone with a gynecological reproductive system who has become pregnant may be at risk of this condition, so being educated on symptoms and presentations may be helpful.
The most common symptoms of postpartum psychosis include the following:
- Confusion
- A significant increase or decrease in energy
- Difficulty falling or staying asleep
- Obsessive thoughts about one’s baby
- Paranoia
- Delusions
- Hallucinations
- Disorganized speech and behavior
- Attempts to harm oneself or their child
Postnatal psychosis most frequently arises while caring for a newborn after childbirth, often within days or weeks of birth. This condition is considered an emergency and can be life-threatening or lead to harmful actions.
Is postpartum psychosis a symptom of postpartum depression?
Postpartum psychosis is not listed as a standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This condition is considered a subtype of “short psychotic disorder” in the Schizophrenia Spectrum and Other Psychotic Disorders category.
However, postpartum depression (PPD) is listed in the DSM-5 as a diagnosable depressive disorder. In rare cases, psychotic symptoms can accompany any type of depression. For this reason, people living with PPD may be at risk of postpartum psychosis.
Depressive symptoms of postpartum depression can include the following:
- Extreme fatigue
- A lack of emotional connection with the newborn
- Numbness or emotional distance
- Difficulty falling or staying asleep
- Increased or decreased appetite
- Anxiety
- A lack of interest in previously enjoyed activities
- A lack of motivation
- Social withdrawal
- Difficulty practicing self-care and hygiene habits
- Hopelessness or thoughts of worthlessness
- Believing one is a “bad parent”
- Desires to no longer be a parent
- Thoughts of suicide and self-harm
If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.
Causes and risk factors for postpartum psychosis
Postpartum psychosis (sometimes called puerperal psychosis, which refers to psychosis that develops in the six-week period following childbirth) has not been found to have one single cause. Experts believe a combination of factors may impact its development, including, but not limited to, those listed below:
- A family history of serious mental illness, especially schizophrenia spectrum or psychotic disorders
- A diagnosis of schizophrenia, a psychotic disorder, delusional disorder, or bipolar disorder
- Birth trauma
- The cessation of psychiatric medication during pregnancy
- A postpartum depression diagnosis
- Previous psychotic episodes
- Younger age (under 25)
- Medical conditions, such as an autoimmune disorder
- Having mood swings while pregnant
- Having a higher weight
- Having an unplanned pregnancy
If you are at high risk for postpartum depression or psychosis, reaching out to a doctor after you give birth may be helpful to be screened for both conditions. However, note that some people may develop this condition even without any risk factors, and some people with the risk factors may not experience postpartum psychosis.
Can postpartum psychosis occur while still pregnant?
Postpartum psychosis is sometimes referred to as “perinatal psychosis” when a psychotic episode is experienced while one is still pregnant, usually a few weeks before giving birth. Fewer studies have been done on psychosis during pregnancy. However, psychotic episodes should always be taken seriously. Reach out to your OBGYN or doctor if you experience new or unusual mental health symptoms while pregnant.
How is postpartum psychosis diagnosed?
Postpartum psychosis is often diagnosed by a medical doctor like a psychiatrist or a licensed mental health provider like a therapist. They may use a psychosis screening tool and interviews to learn more about your symptoms. Other tests might include blood tests and imaging scans, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans.
If you are still pregnant, the doctor might examine your baby to see how it is developing and if there are any complications.
How is postpartum psychosis treated?
If you believe you or a loved one could be experiencing psychosis, seek support immediately. Treating psychosis in the early stages may improve one’s chances of a quick recovery. Below are a few options for support.
Call a hotline or go to the hospital
If you are in active psychosis, do not wait to get help. Call one of the hotlines listed above to ask for support. You can also go to your local hospital emergency department to talk to them about your symptoms. Hospital staff are typically trained to screen for psychosis and other mental health emergencies.
If you’re unsure how to care for your children while seeking help, it might be helpful to talk to the Postpartum Support International HelpLine at 1-800-4773. They may be able to help you find childcare support in your area. Caring for your mental health and your child’s well-being is a priority, and you’re not weak for seeking help.
Consider a support group
Postpartum Support International lists two online support groups that may be helpful for people experiencing the aftereffects of psychosis:
You can also search for local support groups to meet with other parents who may have experienced similar symptoms or challenges. If you are in active psychosis, consider seeking crisis resources before attending support groups, which generally cannot provide the necessary support for acute symptoms.
Talk to a doctor or psychiatrist about medication
Medication can is often a firstline treatment for psychosis and can effectively reduce psychotic symptoms. By speaking to a doctor, like a psychiatrist, a client can discuss the possibility of antipsychotics or antidepressants to regulate their mood. Typical and atypical antipsychotic medications are often prescribed. Because postpartum psychosis is normally a temporary condition, your doctor might monitor your symptoms and guide you to gradually decrease the dosage and discontinue the medication. In rare cases, doctors may use medical interventions like electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) to manage symptoms.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Practice self-care
Self-care can be helpful when recovering from a psychotic episode. Caring for yourself may prevent further difficulties and help you regulate your mood throughout the day. When you care for yourself, you may be better able to care for your child. Below are a few self-care activities to try:
- Engaging in physical movement, such as walking, taking a swim class, or going to a dance class that allows you to take your baby with you
- Eating nutritious meals that nourish your body
- Asking family members and other support individuals to care for your baby during difficult moments after giving birth
- Reaching out to a crisis line if you notice symptoms starting to appear again
- Journaling about your experiences with psychosis and birth
- Practicing daily hygiene
- Partaking in your hobbies, such as art, cooking, or sewing
- Listening to music
- Spending time in groups, such as a parenting group or support group
Talk to a therapist
Although therapy may not be an immediate crisis resource, talking to a therapist can be helpful before or after a psychotic episode has occurred to help you make a safety plan, develop coping mechanisms, and move forward. However, new parents are often busy and may struggle to find an in-person therapist to meet their scheduling needs. In these cases, online therapy platforms like BetterHelp may be a more convenient option.
With an online platform, you can be matched with a therapist who meets your needs and has experience treating individuals struggling with postpartum mental health challenges. In addition, you can choose between phone, video, or live chat sessions at a time that fits your schedule.
Online therapy has been extensively studied in the context of depression, which can commonly occur alongside postpartum psychosis or after a psychotic episode. In one study, online therapy tended to be more effective than in-person options at reducing depression symptom severity and increasing quality of life.
Takeaway
Frequently asked questions
What are the red flags of postpartum psychosis?
Postpartum psychosis often features prodromal symptoms, which are symptoms that appear before the onset of the main symptoms of a particular condition. In the case of postpartum psychosis, prodromal symptoms often include irritability, mood changes, confusion, and insomnia. Prodromal symptoms usually begin three to ten days after birth. It is often helpful to encourage a woman to contact a medical or mental health professional if she experiences a significantly depressed mood, an increase in irritability, or difficulty sleeping beyond what is typical after giving birth.
Postpartum psychosis is a rare condition, but other concerns, such as perinatal depression or panic attacks during the postpartum period, can also substantially impact the well-being of both mother and child. While serious complications are rare, working with a professional for help is typically helpful. Women typically experience mood changes, trouble sleeping, and difficulty focusing after giving birth. Those symptoms are not often due to mental health conditions but rather to the substantial physical and mental demands of taking care of a newborn while recovering from giving birth, often referred to as the “baby blues.” While postpartum blues are not a medical emergency, support from others can help relieve the burdens of caring for a newborn.
What are the early warning signs of psychosis?
Some of the early warning signs of psychosis include irritability, mood disturbances, and insomnia. However, those warning signs may not indicate that more severe symptoms are imminent and may be caused by mental health conditions unrelated to psychosis. For example, a mood disorder like major depression can cause the same symptoms without eventually leading to psychosis. If you’re concerned about the possibility of experiencing psychosis or you need help with mental health, consider reaching out to a professional for assistance. A therapist or other professional can likely recommend a specific treatment to help you manage your concerns.
Who is most likely to get postpartum psychosis?
Evidence suggests that the risk of developing postpartum psychosis is highest in those with a personal or family history of the condition. Research also indicates that a disordered brain structure may be able to be identified through neuroimaging before a psychotic state occurs. If a woman has had an episode of postpartum psychosis during a previous pregnancy or has a family member who has experienced the condition, it is more likely that they will demonstrate psychotic symptoms. In severe cases that require hospitalization, a woman and her child may be placed together on a Mother and Baby Unit (MBU) to increase treatment options.
Other factors that lead to a higher risk of postpartum psychosis include younger age, low per-capita income, the presence of pregnancy complications, and the absence of adequate support following birth. It is also possible that stress following birth, often induced by not getting enough sleep, too many visitors, and the physical adversity of recovering from giving birth, could induce or exacerbate psychotic symptoms.
What causes psychosis in pregnancy?
The exact causes of psychosis during pregnancy are not completely understood, but some of the common factors associated with the condition include:
- Hormonal changes. Pregnancy involves significant hormonal changes and fluctuations, which may contribute to psychosis.
- Inflammatory diseases. Inflammation in the brain, often caused by immune system dysfunction, might contribute to psychosis.
- Genetics. The likelihood of developing psychosis increases if a family member has experienced the condition, suggesting that a genetic component may play a role.
- Stress. Pregnancy, birth, and recovery can all be sources of extreme mental and physical stress, which may trigger psychosis.
What is an example of a psychosis?
The main defining feature of psychosis is a loss of contact with reality. A person experiencing a psychotic episode may struggle to identify what is and is not real. They may experience delusions and hallucinations. Delusions are false beliefs that cannot be real, such as people on television directly speaking to the person experiencing psychosis. Hallucinations involve seeing or hearing things that do not exist. Those experiencing psychosis might also become irritable, paranoid, and withdrawn. Psychosis can occur in many mental health conditions, such as schizophrenia, severe depression, or peripartum mental health disorders.
Can breastfeeding cause nightmares?
There is no evidence to suggest that breastfeeding directly causes nightmares. However, the hormonal changes, sleep disturbances, and general stress of caring for a newborn might make nightmares more likely, especially in the first few weeks after birth. If a woman is breastfeeding during this period, she might associate her nightmares with feeding her child, which is likely how the misconception arose.
How do I know if I'm experiencing psychosis?
It is often challenging for an individual to know whether they are experiencing psychotic symptoms. Those with chronic mental health conditions commonly associated with psychosis, such as schizophrenia, may be able to recognize the early signs of a psychotic episode with practice and guidance, but most people will find it challenging to do so. The lack of specificity of early psychosis symptoms, such as irritability, paranoia, and confusion, further compounds the issue. Those symptoms can appear due to several mental health and medical causes and do not always indicate the onset of psychosis.
By definition, those experiencing psychosis struggle to understand what is and is not part of reality. It is possible that a friend or family member could identify the thought and behavior changes associated with psychosis, such as delusional beliefs or hallucinations. Psychotic symptoms are often easily identified by outside observers, who may be able to see where the person experiencing symptoms has departed from reality.
What can trigger psychosis?
There are no universal triggers for psychosis that apply to everyone. Genetics likely play a role, and a person’s genetic profile might play a role in determining whether they will experience a psychotic episode. Stress is also commonly implicated, as those who are vulnerable to psychotic episodes often report experiencing them following periods of high duress. Some medical conditions, such as inflammatory disorders, electrolyte imbalances, and substance use disorders, can alter brain activity and may make a psychotic episode more likely.
Traumatic brain injuries and dementia might also contribute to the development of psychosis. A neurological exam might reveal damage to the brain that makes psychosis more likely. Sleep deprivation is also commonly implicated. A sleep-deprived person may be more likely to experience psychosis, especially if they have another risk factor or underlying condition that increases the likelihood of a psychotic episode.
What is stage one of psychosis?
The early signs of psychosis typically include irritability, paranoia, confusion, and social withdrawal. Sleep disturbances might also appear. However, those symptoms can also appear in other conditions besides psychosis, and a person who notices a low mood, paranoia, or other major shifts in thoughts and behavior should seek professional guidance. A professional can help identify the right treatment and address the symptoms’ underlying causes.
In some cases, psychosis can escalate rapidly. If symptoms involve self-harm or the person otherwise appears to be a danger to themselves or others, immediate treatment is required. Medical and mental health professionals can identify underlying causes and recommend treatment options to manage the psychosis, which often includes medication and, in some cases, residential care to help the person achieve a full recovery.
What triggers postpartum psychosis?
There isn’t a universal trigger for postpartum psychosis, but some of the commonly reported triggers include stress and sleep deprivation. Postpartum psychosis can be severe and is considered a medical emergency. While many women experience difficulty bonding with their new child and may feel the “baby blues” for the first several weeks after giving birth due to the stress of caring for a newborn, postpartum psychosis represents a departure from reality and rational thought. It may not be clear to the person experiencing it whether a psychotic episode is occurring. Their partner or other family members might be the first to recognize that psychosis is occurring. If postpartum psychosis is suspected, professional help should be sought immediately.
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