Puerperal Psychosis

  • Jaime del Corral Serrano


The period of time after childbirth is, by far, the time of life of the woman in which the incidence of psychosis is the highest. Numerous cultural, psychological, and biological stressors converge around motherhood. Clinical aspects of the various forms of puerperal psychosis, and a specific and well-defined clinical picture (the “classical puerperal psychosis” described in the ancient texts), are addressed. The emergence of this disease has important prognostic implications, and because of its characteristics, it is difficult to determine the overall risk rate. The absence of standardized classification criteria for puerperal psychosis has meant that, in many studies, they have been considered almost exclusively as part of the major psychiatric syndromes, such as bipolar disorder. At present, it seems to prevail a biological paradigm in explaining these disorders, although numerous scientific data support the idea that should be considered from a complex and dimensional perspective.


Puerperal psychoses Postpartum psychosis Perinatal psychosis Women psychosis and affective psychosis 


  1. 1.
    Hamilton JA. Postpartum psychiatric problems. St. Louis, MO: Mosby; 1962.Google Scholar
  2. 2.
    Klompenhouwer JL. Puerperal psychosis. PhD thesis. Rotterdam: University of Rotterdam; 1992.Google Scholar
  3. 3.
    Klompenhouwer J, van Hulst A, Tulen J, Jacobs M, Jacobs B, Segers F. The clinical features of postpartum psychoses. Eur Psychiatry. 1995;10:355–67.PubMedCrossRefGoogle Scholar
  4. 4.
    Katona CLE. Puerperal mental illness: comparisons with non-puerperal controls. Br J Psychiatry. 1982;141:447–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Brockington IF, Cernik KF, Schofield EM, et al. Puerperal psychosis: phenomena and diagnosis. Arch Gen Psychiatry. 1981;38:829–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Dean C, Williams RJ, Brockington IF. Is puerperal psychosis the same as bipolar manic-depressive disorder? A family study. Psychol Med. 1989;19(3):637–47.PubMedCrossRefGoogle Scholar
  7. 7.
    Berrios GE. The history of mental symptoms. Descriptive psychopathology since the nineteenth century. Cambridge: Cambridge University Press; 1996. p. 238–9.CrossRefGoogle Scholar
  8. 8.
    Laín Entralgo P. Historia de la Medicina. Barcelona: Elsevier, Masson; 1978, reimpresión 2006.Google Scholar
  9. 9.
    Brockington I. Late onset postpartum psychoses. Arch Womens Ment Health. 2017;20(1):87–92. Published online 6 Oct 2016.PubMedCrossRefGoogle Scholar
  10. 10.
    Esquirol E. Des maladies mentales considérées sous leur rapport medical, hygiénique et medicolégal. Paris: Librairie de l’Académie Royale de Médecine; 1838.Google Scholar
  11. 11.
    Ey H, Bernard P, Brisset C. Tratado de psiquiatría. Barcelona: Masson; 1965. p. 708–16.Google Scholar
  12. 12.
    Bonhoeffer K. Die exogenen Reactionstypen. Archiv f Psychiatrie und Nervenkrankheiten. 1917;58:58–70.CrossRefGoogle Scholar
  13. 13.
    Dean C, Kendell RE. The symptomatology of puerperal illnesses. Br J Psychiatry. 1981;139:128–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Kohl C. Postpartum psychoses: closer to schizophrenia or the affective spectrum? Curr Opin Psychiatry. 2004;17:87–90.CrossRefGoogle Scholar
  15. 15.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed, revised. Washington, DC: APA, 1987.Google Scholar
  16. 16.
    Word Health Organization. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: Word Health Organization; 1992.Google Scholar
  17. 17.
    McGorry P, Connell S. The nosology and prognosis of puerperal psychosis: A review. Compr Psychiatry. 1990;31(6):519–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Klompenhouwer JL, van Hulst AM. Classification of postpartum psychosis: a study of 250 mother and baby admissions in the Netherlands. Acta Psychiatr Scand. 1991;84:255–61.PubMedCrossRefGoogle Scholar
  19. 19.
    Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Espinoza AM, Peralta MI. Psicosis puerperales. Alcmeon, Revista Argentina de Clínica Neuropsiquiátrica. 1995;4(5).Google Scholar
  21. 21.
    Hays P, Douglas A. A comparison of the puerperal psychosis and the schizophreniform variant of manic depression. Acta Psychiatr Scand. 1984;69:177–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Muñoz RA. Postpartum psychosis as a discrete entity. J Clin Psychiatry. 1985;46:5.Google Scholar
  23. 23.
    Amard T. Traité analytique de la folie. 1807.Google Scholar
  24. 24.
    Krafft-Ebing R. Psychosis Menstrualis. Eine klinisch-forensische Studie. Stuttgart: Enke; 1902 (Ger).Google Scholar
  25. 25.
    Brockington I. Menstrual psychosis. World Psychiatry. 2005;4:9–17.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Jolly P. Menstruation und Psychosen. Arch Psychiatrie Nervenkr. 1914;55:637–686 (Ger).CrossRefGoogle Scholar
  27. 27.
    Hopker SW, Brockington IF. Psychosis following hydatidiform mole in a patient with recurrent puerperal psychosis. Br J Psychiatry. 1991;158:122–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Vanderkruik R, et al. The global prevalence of postpartum psychosis: a systematic review. BMC Psychiatry. 2017;17(1):272.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Vesga-Lopez O, et al. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65(7):805–15.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull. 2003;67:219–29.PubMedCrossRefGoogle Scholar
  31. 31.
    Doucet S, Jones I, Letourneau N, Dennis CL, Blackmore ER. Interventions for the prevention and treatment of postpartum psychosis: a systematic review. Arch Womens Ment Health. 2011;14(2):89–98.PubMedCrossRefGoogle Scholar
  32. 32.
    Brockington IF. Infanticide. Motherhood and mental health. Oxford: Oxford University Press; 1996.Google Scholar
  33. 33.
    Howard LM, Goss C, Leese M, Thornicroft G. Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth. Br J Psychiatry. 2003;182:63–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Blackmore ER, Jones I, Doshi M, Haque S, Holder R, Brockington I, Craddock N. Obstetric variables associated with bipolar affective puerperal psychosis. Br J Psychiatry. 2006;138:32–6.CrossRefGoogle Scholar
  35. 35.
    Robertson E. Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis. Br J Psychiatry. 2005;186(3):258.PubMedCrossRefGoogle Scholar
  36. 36.
    Parfitt Y, Pike A, Ayers S. The impact of parents’ mental health on parent-baby interaction: a prospective study. Infant Behav Dev. 2013;36(4):599–608.PubMedCrossRefGoogle Scholar
  37. 37.
    Chaudron LH, Jefferson JW. Mood stabilizers during breastfeeding: a review. J Clin Psychiatry. 2000;61:79–90.PubMedCrossRefGoogle Scholar
  38. 38.
    Gelder MG, López-Ibor JJ, Andreasen N. Tratado de Psiquiatría. Barcelona: Ars Medica; 2003. p. 1434–5.Google Scholar
  39. 39.
    Marks M, Lovestone S. The role of the father in parental postnatal mental health. Br J Med Psychol. 1995;68(Pt 2):157–68.PubMedCrossRefGoogle Scholar
  40. 40.
    Mead M. Sexo y temperamento. México: Paidós; 1990.Google Scholar
  41. 41.
    Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry. 2001;158(6):913–7.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Jones I, Hamshere M, Nangle JM, Bennett P, Green E, Heron J, Segurado R, Lambert D, Holmans P, Corvin A, Owen M, Jones L, Gill M, Craddock N. Bipolar affective puerperal psychosis: genome-wide significant evidence for linkage to chromosome 16. Am J Psychiatry. 2007;164(7):1099–104.PubMedCrossRefGoogle Scholar
  43. 43.
    De Witte LD, et al. Are infectious agents involved in the pathogenesis of postpartum psychosis? J Affect Disord. 2018;229:141–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Rapkin AJ, Mikacich JA, Moatkef-Imani B, Rasgon N. The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Curr Psychiatry Rep. 2002;4:419–28.PubMedCrossRefGoogle Scholar
  45. 45.
    Hannah P, Adams D, Glover V, Sandler M. Abnormal platelet 5-hydroxytrptamine uptake and imipramine binding in postnatal dysphoria. J Psychiatr Res. 1992;26:69–75.PubMedCrossRefGoogle Scholar
  46. 46.
    Ahokas A, Aito M. Role of estradiol in puerperal psychosis. Psychopharmacology. 1999;147:108–10.PubMedCrossRefGoogle Scholar
  47. 47.
    Kumar C, McIvor RJ, Davies T, et al. Estrogen administration does not reduce the rate of recurrence of affective psychosis alter childbirth. J Clin Psychiatry. 2003;64:112–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Bergink V, Kushner SA, Pop V, Kuijpens H, Lambregtse-Van den Berg MP, Drexhage RC, Wiersinga W, Nolen WA, Drexhage HA. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. Br J Psychiatry. 2011;198(4):264–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Bergink V, Burgerhout KM, Weigelt K, Pop VJ, de Wit H, Drexhage RC, Kushner SA, Drexhage HA. Immune system dysregulation in first-onset postpartum psychosis. Biol Psychiatry. 2013;73(10):1000–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Shaaban HS, Choo HF, Sensakovic JW. Anti-NMDA-receptor encephalitis presenting as postpartum psychosis in a young woman, treated with rituximab. Ann Saudi Med. 2012;32(4):421–3.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Salmaso N, Nadeau J, Woodside B. Steroid hormones and maternal experience interact to induce glial plasticity in the cingulate cortex. Eur J Neurosci. 2009;29(4):786–94.PubMedCrossRefGoogle Scholar
  52. 52.
    Magiakou MA, Mastorakos G, Rabin D, Dubbert B, Gold PW, Chrousos GP. Hypothalamic corticotropin-releasing hormone suppression during the postpartum period: implications for the increase in psychiatric manifestations at this time. J Clin Endocrinol Metab. 1996;81(5):1912–7.PubMedGoogle Scholar
  53. 53.
    Patil NJ, Yadav SS, Gokhale YA, Padwa N. Primary hypoparathyroidism: psychosis in postpartum period. J Assoc Physicians India. 2010;58:506–8.PubMedGoogle Scholar
  54. 54.
    Yu AY, Moore FG. Paraneoplastic encephalitis presenting as postpartum psychosis. Psychosomatics. 2011;52(6):568–70.PubMedCrossRefGoogle Scholar
  55. 55.
    Bergink V, Armangue T, Titulaer MJ, et al. Autoimmune encephalitis in postpartum psychosis. Am J Psychiatry. 2015;172:901–8.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Veen C, et al. P. 1. e. 010 Tryptophan pathway alterations in the postpartum period and in acute postpartum psychosis and depression. Eur Neuropsychopharmacol. 2015;25:S215.CrossRefGoogle Scholar
  57. 57.
    Sharma V. Role of sleep loss in the causation of puerperal psychosis. Med Hypotheses. 2003;61(4):477–81.PubMedCrossRefGoogle Scholar
  58. 58.
    Terp IM, Mortensen PB. Post-partum psychoses. Clinical diagnoses and relative risk of admission after parturition. Br J Psychiatry. 1998;172:521.PubMedCrossRefGoogle Scholar
  59. 59.
    Brockington I. Postpartum psychiatric disorders. Lancet. 2004;363:303.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Shahani L. A father with postpartum psychosis. BMJ Case Rep. 2012;2012:bcr1120115176. Scholar
  61. 61.
    latz C, Kendell RE. A matched-control follow-up and family study of “puerperal psychoses”. Br J Psychiatry. 1988;153:90–4.CrossRefGoogle Scholar
  62. 62.
    Davidson J, Robertson E. A follow-up study of postpartum illness, 1946–1978. Acta Psychiatr Scand. 1985;71:451–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. 2012;69(4):428–34.PubMedCrossRefGoogle Scholar
  64. 64.
    Burgerhout KM, Kamperman AM, Roza SJ, Lambregtse-Van den Berg MP, Koorengevel KM, Hoogendijk WJ, Kushner SA, Bergink V. Functional recovery after postpartum psychosis: prospective longitudinal study. J Clin Psychiatry. 2017;78(1):122–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Bergink V, et al. Treatment of psychosis and mania in the postpartum period. Am J Psychiatr. 2015;172(2):115–23.PubMedCrossRefGoogle Scholar
  66. 66.
    Bergink V, Bouvy PF, Vervoort JSP, Koorengevel KM, Steegers EAP, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. Am J Psychiatry. 2012;169:609–15.PubMedCrossRefGoogle Scholar
  67. 67.
    Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L, Manber R, Viguera A, Suppes T, Altshuler L. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161:608–62.PubMedCrossRefGoogle Scholar
  68. 68.
    Brockington I. Some unusual forms of early onset postpartum psychosis. Arch Womens Ment Health. 2017;20(1):71–6.PubMedCrossRefGoogle Scholar
  69. 69.
    de Beauvoir S. El Segundo Sexo. Trad. Juan María Puente. Buenos Aires: Sudamericana; 1999.Google Scholar
  70. 70.
    Shapiro S, Nass J. Postpartum psychosis in the male. Psychopathology. 1986;19:138–42.PubMedCrossRefGoogle Scholar
  71. 71.
    Maldonado-Durán M, Lecanne EF. El padre en la etapa perinatal. Perinatol Reprod Hum. 2008;22:145–54.Google Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jaime del Corral Serrano
    • 1
  1. 1.Dual Pathology, PsychiatryClínica Nuestra Señora de la PazMadridSpain

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