Postpartum psychosis

Rapid onset days-weeks after birth, severe sleep loss, confusion, bizarre beliefs, hallucinations. Psychotic/manic with impaired reality testing

EmergentReview due

Compare (8)

At a glance

High risk: Yes
Onset: Days to weeks
Course: Rapid
Treatable: Yes

Safety snapshot

Watch forRisk to mother and infantinfanticidal/suicidal behavioursevere sleep lossrefusal of caresuicideinfanticide

Presentation hinge

Separates perinatal intrusive thoughts from postpartum psychosis and genuine harm intent.

Separates the Perinatal Acute Psychiatry group. It is not specific to Postpartum psychosis.

Do now

1Treat this as a psychiatric emergency: onset is typically within the first two weeks and deterioration can be measured in hours
2Ask explicitly about thoughts of harm to the infant and about delusional beliefs involving the baby, and record the answers
3Exclude a medical cause: infection, eclampsia, thyroiditis, anaemia and retained products, with bloods and observations
4Arrange urgent psychiatric admission and do not leave mother and infant unsupervised while the assessment is in progress
5Involve the perinatal mental health service and consider a mother and baby unit where local capacity allows

Locally authored, reviewed by PsychSift on 27 September 2026

Clinical review

Rows marked “Whole group”: Applies to the Perinatal Acute Psychiatry group — not specific to Postpartum psychosis

Why it fits

Rapid onset days-weeks after birth, severe sleep loss, confusion, bizarre beliefs, hallucinations. Psychotic/manic with impaired reality testing

Key features2 features

Rapid-onset confusion, bizarre beliefs, hallucinations, marked mood lability, agitation, severe insomnia days-weeks after birth
Psychotic or manic syndrome with abrupt change from baseline in the postpartum period.

Must-not-miss

Risk to mother and infant, infanticidal/suicidal behaviour, severe sleep loss, refusal of care.

High-risk causes6 causes

Risk to mother and infant
infanticidal/suicidal behaviour
severe sleep loss
refusal of care
suicide
infanticide

Bedside question

Applies to the Perinatal Acute Psychiatry group.

Separates perinatal intrusive thoughts from postpartum psychosis and genuine harm intent.

Helpful clues1 clue

Psychotic or manic syndrome with abrupt change from baseline in the postpartum period.

Immediate action

Applies to the Perinatal Acute Psychiatry group.

None listed

Priority steps

Investigations

Applies to the Perinatal Acute Psychiatry group.

None listed

Core tests

Mimics / overlap

Applies to the Perinatal Acute Psychiatry group.

None listed

Consider

Do now

1Treat this as a psychiatric emergency: onset is typically within the first two weeks and deterioration can be measured in hours
2Ask explicitly about thoughts of harm to the infant and about delusional beliefs involving the baby, and record the answers
3Exclude a medical cause: infection, eclampsia, thyroiditis, anaemia and retained products, with bloods and observations
4Arrange urgent psychiatric admission and do not leave mother and infant unsupervised while the assessment is in progress
5Involve the perinatal mental health service and consider a mother and baby unit where local capacity allows

Locally authored, reviewed by PsychSift on 27 September 2026

Watch for

Risk to mother and infant
infanticidal/suicidal behaviour
severe sleep loss
refusal of care
suicide
infanticide

Also consider

Source and review

Review due· Unverified

v10 · exported 2026-07-11

Clinical reference — not validated decision support. Review before use.