Diagnosis and tests for postpartum psychosis

Urgent clinical assessment

• An urgent psychiatric assessment should be carried out with the patient.
• Whenever possible, information should also be obtained from the partner or family, as the patient may have limited awareness of their condition.
• The assessment should include a detailed mental state examination to identify:
  • Disorganised thinking.
  • Delusions and hallucinations.
  • Extreme and rapid changes in mood.
  • Severe insomnia, particularly when the person does not feel tired despite having little or no sleep.
  • Changes in behaviour and risk-taking or unsafe behaviour.
• Any immediate risk to the mother or baby.

Clinical history

• A personal or family history of:
  • Postpartum psychosis.
  • Bipolar disorder.
  • Other previous psychiatric conditions.
• Previous or recent treatment with psychiatric medication.
• Changes to medication during the perinatal period, such as stopping treatment during pregnancy.
• Use of drugs or other substances.

Additional tests (to rule out other causes)

As postpartum psychosis is often the first episode of a severe psychiatric illness, it is important to rule out physical or other non-psychiatric conditions that can cause similar symptoms.

• Blood tests may be carried out to check for:
  • Hormonal abnormalities: thyroid function.
  • Infections: full blood count and C-reactive protein (CRP).
  • Metabolic abnormalities: electrolyte levels and kidney and liver function.
  • Nutritional deficiencies: vitamin B12 and folate, depending on the clinical context.
• Ruling out neurological conditions:
  • A neurological assessment should be considered.
  • Brain imaging, such as a CT scan or MRI, may be considered if there are:
    • Neurological deficits.
    • Changes in the level of consciousness.
    • Seizures.
    • An atypical onset or course that is not consistent with postpartum psychosis.
• Screening for medication or substance use.