Journalist Information

Postpartum Psychosis – Media Information

Episodes of severe mental illness such as mania or psychosis follow 1-2 in 1000 deliveries

An average size maternity unit would see 8-10 cases of rapid onset psychosis following childbirth in a year. Around 1300 cases occur each year in the UK.

It strikes at a time when families are full of expectation. Mothers feel loss, guilt, responsibility for missing out on the early months of motherhood. Fathers become responsible for a newborn or are separated from their families. They do not know if their partners will fully recover.

PP can occur to women from all social classes, occupations, and educational backgrounds. Often it occurs ‘out of the blue’ to women without any previous psychiatric history.

The stakes are high if the illness is not identified sufficiently early, or is poorly managed, both in terms of maternal outcome (including risk of suicide) and child outcome (including rare and tragic cases of infanticide).

According to The Confidential Enquiries into Maternal and Child Health (www.cmace.org.uk) suicide was the leading cause of maternal death up until the last enquiry and is still one of the leading causes. Half of these suicides occur to mothers suffering the acute onset of psychotic illness. Completed suicides are the tip of the iceberg in terms of ‘near miss’ events occurring to women who develop PP.

PP is eminently treatable, but services must respond quickly and appropriately to these psychiatric emergencies. Episodes have a rapid onset, usually within days of delivery and may escalate to full blown psychosis quickly – within hours or days.

Although episodes of PP are among the most severe illnesses seen in clinical practice, PP also has one of the best prognoses.

Acute symptoms are similar to that of bipolar disorder and may include: extreme elation or euphoria, rapid mood changes, or depressed mood; the rapid onset of unusual beliefs; visual and auditory hallucinations; extreme confusion; and behaviour can be very bizarre. Episodes can be very frightening for women and their families.

The causes of PP are unknown, but the dramatic hormonal and biological changes that occur at childbirth are thought to be involved. There is some evidence of a genetic component to the illness and of a link with bipolar disorder. One in 4 women with a history of bipolar disorder experience PP following childbirth.

The majority of women are substantially recovered within a few months, but full recovery and coming to terms with the illness may take some time longer.

Recovery is a difficult and lengthy process. Factors that contribute to these difficulties include: limited availability of information about PP and recovery; isolation caused by lack of visible others who have experienced the illness; poor awareness in the general public and media; the stigma and shame associated with experiencing mental illness, particularly at this time when women have high hopes of new motherhood; difficulties coming to terms with the experience of a mental illness and behaviours during the illness; low levels of specialist psychological and practical support following hospital admission with managing recovery, looking after a baby, rebuilding relationships, trusts and mothering confidence.

Misguided portrayals in the media contribute to mothers' feelings of isolation and to difficulties in discussing their experiences with other mothers. Often, when women or their partners search the internet for information about their illness, alarmist media stories about mothers harming their babies are the first they encounter.

PP is not simply a more severe form of postnatal depression. In fact, many mothers with PP do not experience any symptoms of depression at all, rather they experience extreme elation, spirituality, and quickly lose contact with reality. The majority of women therefore are unable to seek help for themselves and others must obtain help for them.

Action on Postpartum Psychosis is a network of women in the UK who have experienced PP and who want to raise public awareness and increase research into the condition. It is run by a team of perinatal academics, women who have experienced the illness, and health professionals.

APP was set up in response to the lack of information available to women and their families and lack of knowledge about the causes of the condition. The network has grown from 50 members in 1996 to a membership of over 500 women throughout the UK. It is not directly funded, and team members volunteer their time. Funds have been secured to help send out newsletters and organise meetings. Funds are sought to run further events, conduct further research, to develop information and resources for women and their families, and to raise public awareness of PP.

Research into PP is vital in order to understand how pregnancy triggers the illness; to help to predict women at risk; to understand factors that increase the risk of an episode; and to develop targeted treatments.

Research is needed into the best management practices to improve women’s experiences of care, and ensure good outcome for mothers and their babies.

Improved availability of information about the illness, recovery and support is vital. This can be achieved by partnerships between researchers, support organisations and those with personal experience of PP.