Lay Summary

Early postpartum symptoms in puerperal psychosis. Heron et al. (2008) BJOG 115, 348-353

Early identification and treatment of postpartum psychosis (PP) is extremely important.  In order to examine the nature of the earliest symptoms in women who develop PP, 127 women recruited from APP were asked to describe the first symptoms they believed to be related to their illness. 

Previously it was believed that symptoms did not occur before days 3-4 following delivery.  However most women in the sample felt that, looking back, they could notice symptoms beginning on day one, and some 10% felt that they began to feel more ‘elated or strong and important’ over the last trimester of pregnancy.  This has implications for the types of hormones we consider to be good candidates for a role in PP.

The most commonly recalled symptoms were feeling ‘excited, elated or high’, feeling ‘more active and energetic’, ‘talking more or feeling chatty’, ‘not being able to, or needing to sleep’ and other symptoms such as ‘feeling anxious or fearful’ or ‘confused, unreal and in a dream world’.  Health professionals rarely ask about these kinds of symptoms, even in women at very high risk of PP episodes.  Indeed they are likely to consider that such women are coping ‘ultra well’ with pregnancy and the demands of new motherhood.  There is a need for health professionals to be aware that these feelings could mark the beginning of a mood disorder and deserve closer scrutiny.  For more information on this study, click here