Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in
every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis
within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can
have a significant adverse impact on the mother, baby and wider family. The nosological status
of postpartum psychosis remains contentious; however, evidence indicates most episodes to be
manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears
to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum
psychosis occurs are poorly understood. This review examines the current evidence with respect
to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date
have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian
rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction
models, informed by prospective cohort studies of high-risk women, are required to identify those at
greatest risk of postpartum psychosis.