Postpartum (Puerperal) Psychosis – Pathophysiology | Diagnosis | Management

Posted on:August 23, 2022
Last Updated: November 24, 2023
Time to read: 30–36 minutes

The early postpartum period is a time of much greater risk than usual for the development of severe psychiatric disorders. [Kendell et al., 1987]

Postpartum or puerperal psychosis (PPP) is a serious form of postnatal psychiatric disorder with a strong and specific association with bipolar disorder. [Munk-Olsen et al., 2006]

Though its prevalence is rare (1-2 per 1,000 women), it is a key risk indicator for future affective disorders. This has significant public health, mental health and economic implications and contributes broadly to the global burden of disease. [VanderKruik et al., 2017][Osborne, 2018]

The exact mechanisms involved in postpartum psychosis remain poorly understood. While childbirth appears to be a potent trigger of severe mood disorders, evidence from aetiological studies indicates that most episodes manifest as bipolar disorders, possibly induced by vulnerabilities to certain perinatal triggers. [Perry et al., 2021]

So far, neurobiological factors such as hormones, immunological dysregulation, circadian rhythm disruption and genetics have all been implicated in the pathogenesis of PPP.  [Perry et al., 2021]

In this article, we discuss the aetiology, risk factors, diagnosis and management of women with postpartum psychosis.