Puerperal Psychosis: Definition and Future Directions

Abstract

Definition is essential in science, and the study of puerperal psychosis has been hampered by the lack of a generally accepted definition. Many studies fail to distinguish between the rare psychosis of early onset, and simple ‘postnatal depression’ which is common during the months following childbirth. The concept of ‘puerperal psychosis’ originates from the observation that hitherto normal women suddenly become insane during the first few days after delivery. If we start with this fact, we can progressively tighten the definition, asking in sequence: (1) During what time period is there an excess of new episodes of psychosis ? (2) What sort of illnesses begin during this period ? (3) When do illnesses of this sort begin ? Onset is sometimes difficult to pinpoint, but the answer that is beginning to emerge is that onset is usually during the first week, and 2 weeks can probably be taken as the limit. The clinical picture includes mania, schizoaffective mania, schizophreniform psychosis and depression, but not hebephrenia or chronic paranoid schizophrenia.