International experts urge the reclassification of postpartum psychosis to improve treatment

An international panel of leading women's mental health experts – including UVA Health's Jennifer Payne, MD – is calling to reclassify postpartum psychosis as its own category of mental illness to improve the care new mothers receive. 

Postpartum psychosis is a severe psychiatric illness that is estimated to strike up to 2.6 out of every 1,000 women after they give birth. Symptoms can include mania, depression with psychotic features, impaired thinking, agitation and irritability. Left untreated, the condition can cause women to commit suicide or kill their babies. It is considered a psychiatric emergency and often requires hospitalization.

The condition is considered one of the most easily identified mental illnesses among women because of its rapid onset and distinctive symptoms, yet it is not recognized in two key resources used for medical treatment and billing: the Diagnostic and Statistical Manual, often called DSM-5, or the International Classification of Disease.

Changing that, Payne and her colleagues say, will improve treatment for postpartum psychosis and ultimately save lives of both mothers and infants.

"Postpartum psychosis is a very rare and serious psychiatric illness which requires a specific treatment approach," said Payne, an expert in reproductive psychiatry at the University of Virginia School of Medicine and the senior author of a new "consensus statement" urging the change. "Recognition of postpartum psychosis as a distinct clinical entity will promote evidence-based, safe and effective treatment."

Recognizing postpartum psychosis

Payne and her collaborators, including experts from the United Kingdom, the Netherlands, India and more, worked closely with patient-advocacy groups, the American Psychiatric Association and other partners to formulate the new recommendations. They note that women typically respond extremely well to existing treatments, such as lithium. These treatments are often used for bipolar disorder, formerly known as manic depression. (Women who develop postpartum psychosis have a 50-50 chance of developing bipolar disorder, while pregnant women who are already diagnosed with bipolar disorder are at extremely high risk for postpartum psychosis.)

The experts argue that postpartum psychosis does not fit into the existing categories of mental illness in the two billing and coding resources. The current descriptions only recognize "peripartum onset," meaning the illness strikes during the period around childbirth. This, the authors say, incorrectly describes how postpartum psychosis can set in weeks or months after delivery.

Recategorizing the illness and detailing its symptoms will speed diagnosis and help ensure women get the care they, and their babies, need, the experts say. To facilitate diagnosis, they have proposed specific criteria, such as depression, delusions and hallucinations, to include in the treatment and coding resources.

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

Jennifer Payne, MD, UVA Health

Findings published

The experts have published their consensus statement in the scientific journal Biological Psychiatry. The article is open access, meaning it is free to read, and includes a comprehensive review of the psychiatric literature on postpartum psychosis.