Postpartum psychosis: an alternate explanation for symptom specificity

Defining postpartum psychosis is simultaneously simple yet complex.1 In short and at the most basic level, postpartum psychosis is the occurrence of a psychotic episode after childbirth. However, delimiting illnesses that constitute postpartum psychosis has been challenging, and it is here that the complexity arises. The fact that postpartum psychosis is not recognized as a distinct diagnosis in DSM-5 or ICD-11 may also contribute to the lack of clarity. Postpartum psychosis is characterized by a rapid onset of symptoms including delusions, hallucinations, bizarre behavior, confusion, and disorganization that may appear to be delirium. Phenomenologically, postpartum psychosis can be subdivided into depressive (41%), manic (34%), and atypical (25%) groups. The atypical profile is marked by disorientation and disturbance of consciousness.2 Similar to postpartum psychosis, the diagnostic status of delirious mania, a neuropsychiatric syndrome with coexisting symptoms of mania and delirium, has been intensely debated. It is argued that the co-occurrence of mania and symptoms of delirium of varying intensity in some patients may contribute to the apparent uniqueness of postpartum psychosis.