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Puerperal psychosis

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

Puerperal psychosis is a serious psychiatric disorder that develops during the perinatal period. It is the most severe form of postpartum affective disorder. The onset is very sudden, the majority presenting in the first 14 days postpartum, most commonly between day 3 and day 7. Features may include:

  • Restlessness and agitation
  • Confusion and perplexity
  • Suspicion and fear, even terror
  • Insomnia
  • Episodes of mania making the woman hyperactive (e.g. talking rapidly and incessantly, and being very overactive and elated)
  • Neglect of basic needs (e.g. nutrition and hydration)
  • Hallucinations and morbid delusional thoughts involving self and baby
  • Major behavioural disturbance
  • Profound depressive mood.

Care and management should be based on:

  • Preventive measures preconception/antenatally
  • Interprofessional collaboration
  • Care in a specialist mother and baby unit.

Further reading

Royal College of Psychiatrists. (2014). Postpartum psychosis: severe mental illness after childbirth. http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/postpartumpsychosis.aspx

NICE. (2014) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline 192. https://www.nice.org.uk/guidance/cg192

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