An international panel of leading experts on women’s mental health is recommending that postpartum psychosis be recognised as a distinct category of mental illness and classified accordingly within standardised medical coding systems.
The recommendation, published in Biological Psychiatry, follows a comprehensive review of the scientific literature on the illness.
Postpartum psychosis is an acute and severe psychiatric illness that sets in within weeks after delivery. Most women with postpartum psychosis experience severe mood symptoms, including mania, mixed episodes, or depression with psychotic features. Impaired cognition, irritability, and agitation are also common.
The condition is considered a psychiatric emergency and, in most cases, requires hospitalisation of the mother. If left untreated, postpartum psychosis is associated with high risks of suicide and infanticide. However, if it is detected and treated in time, patients respond well to treatment and most women return to their previous functioning.
Despite being one of the most distinct clinical phenotypes in psychiatry, postpartum psychosis is not recognized in the Diagnostic and Statistical Manual (DSM-5) or the International Classification of Disease (ICD), which are used to code diseases and medical conditions for treatment and billing purposes.
The panel, in close collaboration with patient advocacy organisations and key interested partners, recommended classifying postpartum psychosis as a distinct category within the bipolar disorders chapter of the DSM and ICD.
“Postpartum psychosis is the most severe perinatal mental health problem, and yet one that is often misdiagnosed and mismanaged, with severe consequences for women, and their children and families. A proper nosological classification of this disorder is an essential step towards its correct identification and treatment”.Professor Paola Dazzan, Professor of Neurobiology of Psychosis, Vice Dean (International) at King’s IoPPN and a member of the research panel
Due to the risks to the patient and the infant, the rapid escalation of severity, and its severe and sudden course, it is imperative that postpartum psychosis is recognized, diagnosed, and treated as early as possible. To facilitate such care, the panel recommends DSM-5 and ICD-10 include the following criteria for a diagnosis of postpartum psychosis:
- The onset of at least one of the following states within 12 weeks of childbirth, lasting at least one week and present most of the day, nearly every day, or any duration if hospitalisation is necessary:
- Mania/mixed state
- Delusions
- Hallucinations
- Disorganised speech or formal thought disorder
- Disorganised, confusional, or catatonic behaviour
- Depression with psychotic features
- The episode is associated with an unequivocal change in functioning that is uncharacteristic of the postpartum period.
- The disturbance in mood and the change in functioning are observable by others.
- The episode is sufficiently severe enough to cause marked impairment in social functioning and in the care of the baby or to necessitate hospitalization to prevent harm to the patient, baby, or others.
“We have been working with the American Psychiatric Association and the DSM steering committee since 2020 to find a solution that will facilitate diagnostic accuracy and the provision of timely and evidence-based treatment to improve the quality of treatment and outcomes for women with postpartum psychosis and to prevent the tragic outcomes of suicide and infanticide. We are committed to continue this work,” concludes Dr Veerle Bergink, Director of the Women’s Mental Health Center at Mount Sinai and first author of the paper.
Source: King’s College London
