Experts urge reclassification of postpartum psychosis to improve care

International experts are calling for postpartum psychosis to be recognised as a separate diagnostic category to improve care for this dangerous mental illness affecting new mothers.

The condition strikes up to 2.6 in every 1,000 women after childbirth and can cause mania, depression with psychotic features, impaired thinking, agitation and irritability.

Without treatment, women may commit suicide or harm their babies.

Despite its rapid onset and distinctive symptoms, postpartum psychosis is not listed in two key medical reference guides — the Diagnostic and Statistical Manual (DSM-5) and the International Classification of Disease.

An international panel of leading women’s mental health experts from the UK, Netherlands, India and the US, led by Jennifer Payne at the University of Virginia School of Medicine, says formal recognition would improve treatment and save lives.

The group worked with patient-advocacy organisations, the American Psychiatric Association and other partners to develop new recommendations.

“Postpartum psychosis is a very rare and serious psychiatric illness which requires a specific treatment approach,” said Payne, an expert in reproductive psychiatry and senior author of the consensus statement.

“Recognition of postpartum psychosis as a distinct clinical entity will promote evidence-based, safe and effective treatment.”

Postpartum psychosis is a psychiatric emergency that often requires hospitalisation.

Symptoms can include hallucinations (seeing or hearing things that are not there) and delusions (false or irrational beliefs). The illness differs from postnatal depression in both severity and the presence of psychotic symptoms.

Women generally respond well to existing treatments such as lithium, a mood stabiliser often used for bipolar disorder (previously known as manic depression).

Around half of those who develop postpartum psychosis later go on to develop bipolar disorder, while women already diagnosed with bipolar disorder during pregnancy face a particularly high risk after giving birth.

Current diagnostic codes only recognise “peripartum onset”, meaning illness occurring around the time of childbirth.

Experts say this description is inaccurate, as postpartum psychosis can appear weeks or even months after delivery.

The panel has proposed diagnostic criteria including depression, delusions and hallucinations to help guide treatment and clinical coding.

They argue that the current classification does not reflect the unique features of the condition, making accurate diagnosis and care more difficult.

“We hope that recognition of postpartum psychosis as a distinct clinical entity will improve identification and outcomes and lead to further research to identify the underlying pathophysiology,” Payne said.

“Postpartum psychosis is treatable, and potentially preventable if we identify the underlying biological basis for the illness.”

The consensus statement includes a comprehensive review of psychiatric research on the condition.

The experts say reclassification would speed diagnosis and ensure mothers and babies receive appropriate care.