What is it?

Postnatal psychosis is a severe psychiatric disturbance where a mother becomes "out of touch'' with reality after the birth of a baby. Some women may also have thoughts of harming themselves or their baby. They may be not be aware that they are behaving abnormally and will have little control over their behaviour.

For many mothers suffering this condition, there has been no previous history of mental illness. It occurs in normal women, living in normal circumstances. It differs from other mental disorders as it appears to be specifically pregnancy-related.

It occurs in about one in 300 pregnancies. The causes of postnatal psychosis are not fully understood, but hormonal and biological imbalances are contributing factors.

It occurs in normal women, living in normal circumstances. It differs from other mental disorders as it appears to be a specifically pregnancy-related psychosis.

What are the symptoms?

This will vary from person to person, but the most common are:

• over-active and over-enthusiastic behaviour
• racy thoughts
• grandiose ideas
• excessive behaviour (ie, spending, writing, cleaning)
• elevated or irritable moods
• delusions (false beliefs)
• hallucinations (abnormal perceptions)
• nightmares
• insomnia
• decreased need for sleep
• difficulty with concentration and coordination
• obsessive religious beliefs.

Some of those affected may talk and think with increased rapidity, eventually becoming disjointed and completely irrational.

Others may experience severe depressive symptoms, including:

• panic attacks
• inadequacy
• obsessive thoughts
• paranoia.

How is it treated?

It is imperative that psychiatric help is sought, because medication is always required for this condition. It does not improve of its own accord. If detected early enough a mother may be treated at home with intensive professional input and support.

Adequate supervision must be available because the woman should not be left alone with the baby when she is very unwell. Hospitalisation is often necessary. Ideally, the mother and baby should not be separated to ensure that bonding is established in the early weeks.

The illness usually occurs in the first three months after childbirth, with most occurring in the first two weeks. The first ones to notice that something is wrong are usually family members.

Following the psychotic episode the woman will need considerable support to come to terms with what has happened to her.

Women have a tendency to relapse after initial improvement. Some doctors are less sympathetic than others, and find it difficult to explain the disorder and its treatment. Change your doctor if you feel it is necessary. It takes time, but a full recovery can be made.

There is a chance the condition will recur with further pregnancies, so it is important to seek psychiatric advice and/or counselling before conception so the risk can be reduced. This can be obtained in the public sector. Postnatal psychosis is an acute illness - not a chronic disease.

Seek help from someone who will be sympathetic. Talking about it will probably help, so don't underestimate your friends.

Other forms of postnatal distress

Postnatal (baby) blues

Fifty percent to 80% of women experience the "blues" on the third or fourth day following delivery. Weepiness is the outstanding feature, along with anxiety, low spirits and poor concentration. Difficulty with breastfeeding can accompany these changes.

Although distressing, the experience is very common. No treatment other than reassurance and support is usually required, for the condition is typically mild and short lived.

Postnatal depression

Ten to 20% of mothers suffer from an episode of depression lasting longer than a month in the year following childbirth. Symptoms can include tearfulness, anxiety, depressed mood, guilt, lack of concentration, poor appetite, feelings of tiredness, inability to cope with the baby and with routine tasks, loss of interest in sexual activity and insomnia.

These symptoms often persist for months and can markedly impair a mother's quality of life. While most depressions clear on their own eventually, help can reduce their severity or shorten the period of suffering.

For further information and support talk to your doctor, psychiatrist or psychologist. Contact your local community mental health centre or one of the Maternal Mental Health teams (usually based at your local public hospital). Look in the front of the telephone directory under Community Health Services for the telephone number.

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Post Natal Psychosis Support Group. Edited by everybody, June 2005.