Early Postpartum Symptoms in Puerperal Psychosis

Objective: To examine the nature of the earliest reported symptoms in women who develop a bipolar affective puerperal psychosis (PP).

Design: A retrospective interview study.

Setting: Women were recruited for clinical and molecular genetic studies of PP from a national PP network, articles in the national press and referrals from UK specialist perinatal psychiatry services.

Sample: One hundred and twenty-seven women met the criteria for an episode of strictly defined bipolar affective PP developing within 4 weeks of childbirth.

Methods: Participants were interviewed using the Schedule for clinical assessment in neuropsychiatry and hospital records were reviewed. Lifetime and puerperal episode diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) based on all the available information. During interview, participants were asked to describe the earliest symptoms they believed to be related to their illness onset. The day of onset for each symptom was recorded.

Main Outcome Measures: We present subjectively experienced emotional and behavioural changes occurring within 3 days of childbirth, reported by four or more women.

Results: Seventy-three percent of women recalled experiencing an onset of symptoms by day 3. The most commonly recalled symptoms were feeling excited, elated or high (52%), not needing to sleep or not able to sleep (48%), feeling active or energetic (37%) and talking more or feeling very chatty (31%).

Conclusions: Hypomanic symptoms are particularly characteristic of the early postpartum in women who develop PP. These types of symptoms should be carefully monitored in individuals at high risk of PP episodes.