Psych: Postpartum Psychosis: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Postpartum Psychosis
🎧 A high-yield breakdown of postpartum psychosis, a rare but severe psychiatric emergency following childbirth – built for MSRA prep and real-world clinical vigilance.

🧠 Key Learning Points

📌 Definition
• Postpartum psychosis (PPP) is a rare, acute psychiatric condition that occurs within the first few weeks after childbirth.
• Characterised by sudden onset of psychotic symptoms (e.g. delusions, hallucinations) and severe mood disturbance.
• It is a psychiatric emergency requiring urgent hospitalisation and intervention.

📌 Causes & Risk Factors
• Multifactorial – hormonal, genetic, psychosocial:

• Rapid drop in estrogen & progesterone

• Family/personal history of bipolar disorder or PPP

• Severe sleep deprivation, social isolation

• Stressful life events or recent discontinuation of mood stabilisers

• First-time mothers, close-spaced pregnancies
  • Mnemonic: "BIO-S" – Bipolar link, Insomnia, Oestrogen/progesterone crash, Stressors

📌 Pathophysiology
• Hormonal fluctuations post-delivery
• Neurotransmitter disruption – dopamine, serotonin
• Underlying genetic predisposition
• Disrupted sleep and HPA axis changes

📌 Symptoms
• Psychotic features:

• Delusions (often baby-related)

• Hallucinations (especially auditory)

• Disorganised thoughts, paranoia, bizarre beliefs
  • Mood disturbance:

• Mania-like elation, irritability

• Severe depression, suicidal ideation
  • Other signs: Agitation, confusion, insomnia, self-neglect
  • ⚠️ Risk to self and infant – urgent action required

📌 Differential Diagnosis
• Psychiatric:

• Severe postpartum depression

• Bipolar disorder

• Schizophrenia

• Major depressive disorder with psychotic features
  • Organic:

• Stroke, infection (sepsis, UTI), thyroid/parathyroid issues

• Electrolyte imbalance, B12/folate deficiency

• Medication side effects, hyperglycaemia
  • Always exclude organic causes first

📌 Diagnosis
• Clinical assessment + mental state exam
• Use of investigations to rule out mimics:

• Mnemonic: B-U-T-C-H + urine + cranial imaging
  • B: FBC
  • U: U&Es
  • T: Thyroid function
  • C: Calcium
  • H: Haematinics (B12, folate)
  • + MSU and brain imaging (CT/MRI)

📌 Management
• Urgent hospital admission – ideally to Mother & Baby Unit
• Antipsychotics for psychosis
• Mood stabilisers (e.g., lithium, valproate)
• Consider ECT in severe/resistant cases
• Psychosocial support: practical help, psychoeducation
• Post-discharge: monitoring, medication planning, relapse prevention
• Ensure family involvement and safety of mother–baby bond

📌 Complications
• Suicide, infanticide
• Prolonged hospitalisation, family breakdown
• Long-term psychiatric morbidity
• Impaired infant bonding, risk of developme

Episode Transcript

(00:00):
All right, welcome to the deep dive.
Today we're tackling a conditionthat's really crucial to
understand postpartum psychosis.Maybe you're deep in revision
mode, or maybe you just want to be really well informed about
maternal mental health. Either way, you're in the right
place because this deep dive, it's built specifically from
your revision notes on this topic.

(00:21):
Our mission is basically to takethe stack of material and, you
know, forge it into a clear highyield guide, hitting all the
essential points without gettinglost.
And this is, well, this is a deep dive that truly matters,
doesn't it? Postpartum psychosis off called
PPP. It's rare, yeah, but it is
incredibly serious. We're talking a genuine
psychiatric emergency. It's got potentially devastating

(00:43):
intercation. So prompt recognition, prompt
intervention, it's vital. Getting a solid handle on it is
just, well, essential. OK, yeah, let's unpack the sun.
Let's jump right in with the fundamentals.
What is postpartum psychosis at its core?
OK, so the core definition from the notes, yeah, it's basically
a rare but very severe psychiatric condition presenting
after childbirth. Severe.

(01:03):
And the key features are that sudden onset of psychotic
symptoms, you know, things like delusions, hallucinations,
really disorganised thinking, and that's combined with very
severe mood disturbances. We typically see this pop up
within the first few weeks afterdelivery.
And the material really stressesthis is a psychiatric emergency.
Absolutely needs immediate medical attention, no question.

(01:26):
And it's so important to understand this is distinct from
postpartum depression. OK PPD is more common sure, but
PPP is like way more severe. Hospitalisation is often needed
for safety, for evaluation, for treatment.
It's a whole different ball gamein terms of severity.
Got it. Distinct severe, needs urgent
help. OK, so that leads us to the why?

(01:47):
Why does this happen? What are the potential causes
behind PPP according to the notes?
Well, the exact cause isn't fully pinned down.
The information suggests it's likely a complex interplay of
factors. Not just one thing yet.
No, definitely not. A big one seems to be those
dramatic hormonal fluctuations after childbirth, especially
that rapid drop in oestrogen andprogesterone.

(02:07):
There's also likely a genetic component involved.
We see that mentioned. And then you've got the
psychosocial factors, things like severe sleep deprivation.
Which is it's almost universal with a newborn.
Exactly, but here it seems to tip the balance.
Also high stress levels, maybe feeling social isolated or just
really struggling to adapt to the huge life change of
motherhood. OK so hormones, genetics,

(02:30):
psychosocial stress, and I noticed a significant link
mentioned to bipolar disorder. Yes, that's a really important
connection highlighted in the material.
For some women, postpartum psychosis might actually be the
first time an underlying bipolardisorder shows itself, or it
could be an episode triggered bythe postpartum period.
So when thinking about the why it's multifactorial, maybe think

(02:54):
hormones, genetics, psychosocialfactors, and maybe sitting on
the spectrum of bipolar disordersort of helps tie it together.
That does help link those ideas.OK.
So knowing the potential causes,who is most vulnerable,
understanding the risk factors feels absolutely crucial for
spotting this early. It really is, and the
information gives us a pretty clear list.
The ones that really jump out with the highest association are

(03:16):
a personal or family history of bipolar disorder or importantly,
a previous episode of PPP itself.
So. If someone's had it before or a
close relative has bipolar or PPC.
Their risk is significantly higher.
That's a major one. Other factors include a history
of any psychotic episodes or other significant mental health
disorders and this is important too if someone has recently

(03:39):
stopped taking mood stabilising medications.
OK. Like coming off lithium or
something similar. Potentially, yeah.
Then there are pregnancy relatedfactors, being a first time
mother, prima parity or having pregnancies very close together.
Lack of social support is a big one, severe sleep disturbance,
as we mentioned, and stressful life events either during the
pregnancy or right after childbirth.

(04:01):
Makes sense? And finally, a couple more a
history of mood symptoms gettingworse before periods, that
premenstrual exacerbation, and just a general family history of
psychiatric conditions. So it sounds like underlying
vulnerability, especially aroundmood and psychosis, then
combined with the physiological shock of childbirth and maybe
lack of support, that creates a higher risk scenario.

(04:24):
Exactly that prior personal or family history is definitely a
major red flag to be aware of. Let's dig a little deeper into
the biological side, the path ofPhysiology.
How do we think these risk factors and triggers actually
translate into the symptoms we see?
What's the mechanism as far as we know?
Well, our understanding based onthe material points back to
those hormonal changes again, especially that rapid drop in

(04:46):
oestrogen and progesterone somehow contributing to the
psychotic symptoms, right? Genetic factors clearly play a
role in susceptibility and thereseem to be alterations and
specific neurotransmitter systems in the brain.
Dopamine and serotonin are mentioned specifically.
The usual suspects and mood and psychosis research.
Pretty much. They're often implicated.
So ultimately, it's viewed as this complex interaction between

(05:09):
these rapid biological shifts and someone's genetic
predispositions. OK.
This leads us to a really critical clinical step,
differential diagnosis. If someone presents with these
worrying symptoms after delivery, what else could it
possibly be? What are the important look
alikes we need to rule out? All right, this is non
negotiable detective work. The notes divide the

(05:31):
possibilities nicely into two camps, psychiatric and,
crucially, organic causes. OK, let's start with the
psychiatric 1. Sure.
On psychiatric side, you need tothink about severe postpartum
depression, maybe with extreme anxiety, a new onset or flare up
of bipolar disorder, major depressive disorder that
includes psychotic features that's a specific subtype, or

(05:52):
potentially schizophrenia, maybea first episode or other primary
psychotic disorders. OK, a range of serious
psychiatric conditions. Yes, but here's where it gets
really interesting, and maybe even more critical in the
immediate term, the absolute necessity of ruling out organic
or medical causes. Right Physical illnesses
mimicking psychiatricals. Exactly, and the list mentioned

(06:14):
is quite extensive. Serious things like stroke,
ischemia, or hemorrhagic electrolyte imbalances.
You know, sodium levels going haywire causing confusion, blood
sugar problems, hyper or hyperglycemia, thyroid or
parathyroid abnormalities. Which can definitely cause mood
and cognitive changes for sure. Severe nutritional deficiencies
like B12 or folate, side effectsfrom medication they might be on

(06:38):
and infections. Sepsis is a big one, or even a
urinary tract infection presenting a typically in this
vulnerable state. OK, I have to ask here.
Why is considering these medicalcauses so incredibly vital?
Why is that the absolute first step even before you land on a
psychiatric diagnosis? Because many of those organic
conditions are immediate medicalemergencies themselves, right?

(07:00):
A stroke, severe sepsis, a majorelectrolyte imbalance.
These need rapid medical treatment.
That's completely different frompsychiatric management.
If you delay treating those because you're only thinking
psychiatrically, the outcome could be, well, fatal.
You must rule out a treatable, potentially life threatening
medical cause first. It's just fundamental patient
safety. That makes perfect sense,

(07:21):
protects against missing something urgent while figuring
out the psychiatric picture, andthe material gives us a helpful
way to think about the key medical tests.
Right, that Butch mnemonic plus a couple extras.
Exactly, it's a good way to remember the core investigations
you typically run to rule out those organic causes.
So Butch plus urine and maybe a head scan.

(07:42):
Let's break that down. OK B is for basic bloods like a
full blood count FBC looking forinfection or anaemia.
U is for urea and electrolytes. U and ES checking kidney
function, those crucial electrolytes.
T is for thyroid function tests.C is for calcium levels.
Hypercalcemia can cause confusion.
H is for Hamatinix B12 fully checking for those deficiencies.

(08:03):
OK, that's Butch than urine. Yeah, urinalysis or a midstream
urine sample MSU to check for a UTIA urinary drug screen might
also be relevant sometimes. It has skin.
Cranial imaging like ACT or MRI,That's if there's any suspicion
of a neurological cause like a stroke, bleed, infection, or
some other structural issue in the brain.

(08:24):
It's essential to exclude those if the clinical picture suggests
it. Brilliant.
So that mnemonic helps guide theinvestigation part, focusing on
excluding those dangerous mimics.
Let's put this in perspective now with some numbers.
What does the epidemiology section tell us?
How common is PPP and who does it affect statistically?
Right. So in the UK, the incidence

(08:45):
figures cited A relatively low about one to two cases per 1000
deliveries. So not common, but clearly
significant when it happens. Precisely.
And as we touched on, the typical onset is quite early,
usually within the first two weeks postpartum, sometimes even
sooner. The stats also reinforce those
risk factors we discussed. There's a significantly higher

(09:05):
risk, the notes mentioned, up toA6 fold increased risk if
there's a family history of PPP or bipolar disorder.
Wow 6 fold. Yeah, and having had a prior
psychiatric hospitalisation related to pregnancy also bumps
up the risk considerably. And here's a really sobering
statistic the material highlights.
PPP is cited as a leading cause of late maternal death in the

(09:25):
UK. That really hits home, doesn't
it? Underscores why this deep dive,
why awareness is so important. Absolutely, it emphasises the
need for vigilance and early intervention, both during
pregnancy and especially in thatvulnerable post Natal period.
OK. Moving from the numbers to the
presentation itself, what does PPP actually look like?

(09:46):
If you were interacting with someone affected, what clinical
features would you typically see?
This feels like the core of recognition.
It usually presents quite suddenly, and it's severe.
The symptoms can vary, of course, but often it's a mix of
psychotic elements and extreme mood disruption.
So let's breakdown those symptoms.
Psychotic first. OK, you might see delusions.

(10:06):
These are often focused on the baby, maybe fears about harming
the baby or that the baby isn't theirs, or sometimes grandiose
ideas related to motherhood. Hallucinations are common,
typically auditory hearing voices, but other senses can be
involved. Then there's disorganised
thinking or speech. The person might seem very
confused, jump from topic to topic or be quite incoherent.

(10:28):
Paranoia is also listed. Feeling overly suspicious,
perhaps fearful of others harming them or the baby, and
holding odd or frankly bizarre beliefs often related to the
baby. OK, that's the psychotic side.
What about the mood and energy changes?
These are profound too. You can see extreme mood swings,
maybe rapidly cycling between feeling very high, elated,

(10:49):
irritable, wired, manic like andthen crashing into severe
depression or despair. There's often severe agitation
or restlessness they just can't settle and sleep is hugely
disturbed. Often profound insomnia,
sometimes even a decreased need for sleep coupled with bursts of
hyperactivity or excessive energy.
Irritability and anxiety are also very common.

(11:11):
That sounds incredibly distressing and, well, chaotic
for the person experiencing it and for those around them.
Absolutely, and other signs can include things like decreased
appetite, neglecting basic self-care, and general confusion
or disorientation about time or place.
And the material explicitly flags a crucial safety concern
here, doesn't it? Yes, and this is paramount.

(11:31):
Cannot be stressed enough. The presence of thoughts of
harming oneself or tragically, thoughts of harming the baby,
the distorted thinking, the delusions, the paranoia caused
by the psychosis can lead to these impulses.
This risk is precisely why the condition is an immediate
medical emergency. Safety first.
Right. Any hint of those thoughts means

(11:52):
urgent, immediate intervention, the material notes.
The severity and duration can vary, but crucially, any of
these symptoms warrant urgent attention, right?
Not just the full blown picture.Precisely you don't wait for it
to look textbook perfect. If there are concerns,
especially around psychosis or severe mood shifts or Safety,
Act quickly. OK, so you suspect PPP based on

(12:13):
these features. You've done your Butch
investigations to rule out organic mimics.
What's next? Section 9 management?
How do you actually treat PPP? What do you do?
Management has to be immediate and comprehensive.
The notes emphasise this. The very first step is almost
always hospitalisation, for immediate stabilisation, for
safety and for close monitoring of both the mother and the baby.

(12:33):
OK. Inpatient care, yes.
Inpatient psychiatric care is essential.
You need a safe environment to manage these severe symptoms.
Urgent assessment, referral and admission are key.
Ideally the notes mentioned to aspecialist mother and baby unit
if one is available. This is the UK context
described. That allows keeping mom and baby
together safely. That's the goal, yes.

(12:55):
Maintaining that bond while ensuring safety.
Medication is a core part of treatment.
Antipsychotic medications are typically used first line to
address the psychotic symptoms. Mood stabilisers like lithium or
valproate are also crucial, especially given that link to
bipolar disorder. They help stabilise the severe
mood swings. Antidepressants might be
considered sometimes, but usually carefully, perhaps after

(13:18):
the acute psychosis and mania are controlled.
What about other treatments? Electroconvulsive therapy or ECT
is mentioned as an effective option.
It's considered for very severe cases.
Or. Perhaps if medications aren't
working well or are contraindicated, maybe due to
breastfeeding choices, ECT can provide quite rapid relief.
OK. So meds and potentially ECT for

(13:39):
the acute phase, What else? Beyond that, psychosocial
support and psychoeducation are vital, helping the woman and her
family understand the condition,how to cope.
Therapy, individual or group, isseen as supportive during
recovery, but the material specifies it doesn't really have
a role in the acute phase itself.
That's about stabilisation. Supportive interventions are

(14:02):
also key, things like practical help with childcare, getting the
family involved and educated, and really working on
maintaining and strengthening that mother infant bond,
avoiding separation whenever it's safely possible.
That seems really important for the long term.
Definitely post discharge planning is also crucial.
Setting up follow up appointments, ensuring ongoing
monitoring and support systems are in place and decisions about

(14:25):
medication, especially if the mother wants to breastfeed, need
careful weighing of the risks and benefits for both mother and
baby. It's an individualised
discussion. Education and support for the
whole family unit is a thread running through the management
plan. It really sounds like a
coordinated, multidisciplinary effort focused squarely on the
safety and well-being of both mother and baby.
Exactly. It's intensive upfront

(14:47):
intervention followed by robust ongoing support tailored to the
individual. So after going through that
intensive treatment, what does the future typically hold?
Let's look at the prognosis section.
Is full recovery common? The good news, generally
speaking, is that with timely and appropriate treatment, the
prognosis for PPP is quite good.That's encouraging.

(15:09):
It is most women do experience significant symptom improvement
and can achieve a full recovery over time.
However, and this is a really critical point for future
planning and counselling, there is a significant increased risk
of recurrence. In future pregnancies.
Yes, especially in future pregnancies, but also
potentially during other periodsof major hormonal fluctuation.

(15:32):
This means close monitoring is absolutely essential in any
subsequent pregnancies. Preventive measures are often
discussed and recommended. This might involve restarting
medication prophylactically during or after the next
pregnancy and ensuring really strong psychosocial support
systems are in place beforehand.The material highlights that the
recurrence risk is relatively high, so that needs to be
managed proactively. The overall prognosis can also

(15:54):
be influenced by things like howsevere the initial episode was,
if there are other coexisting conditions, the quality of
social support available, and ofcourse, how well treatment is
adhered to. So recovery is the norm with
treatment, which is great news, but vigilance and planning are
absolutely key for the future, especially around subsequent
pregnancies. That sums it up well.

(16:16):
Finally, let's look at the flip side complications.
What happens if PPP is not treated effectively or promptly?
What are the risks? If left untreated, the
consequences are frankly severe and potentially tragic for both
the mother and the infant. Throughout the mother.
The risks include self harm, suicide attempts or completion
and as we mentioned earlier, that awful risk of harming the

(16:37):
baby driven by the distorted psychotic thinking.
Untreated, it inevitably leads to prolonged hospitalisation,
often necessary separation from the baby, and can have a
significant long term negative impact on the mother's mental
health or relationships and her overall functioning.
And for the infant, that must bedevastating too.
Terribly so. There can be impaired bonding

(16:59):
between mother and infant, whichhas long term implications.
Significant difficulties with caregiving because the mother is
so unwell. This increases the risk of child
neglect, even if unintentional, and infants can experience
emotional and developmental difficulties down the line as a
consequence of that disrupted early caregiving environment and
exposure to maternal distress. Those are really devastating

(17:21):
potential outcomes. It it truly underscores why
prompt identification intervention, getting that help
immediately. It's not just important, it's
potentially life saving for both.
Absolutely immediate action and comprehensive ongoing support
are crucial to minimising these terrible complications and
helping the whole family unit recovery and thrive.
Wow. OK.

(17:42):
We've really covered a lot of critical ground there.
Following the path laid out in your notes.
We went from defining postpartumpsychosis, stressing its
emergency nature, exploring the potential causes, the why and
who's most at risk. We looked at the biology, the
pathophysiology, navigated that crucial step of differential
diagnosis, ruling out those organic mix with things like the

(18:03):
Butch cheques. We touched on the epidemiology,
the numbers described what PPP actually looks and feels like,
those clinical features, then outline the investigation
process, the comprehensive management strategies including
hospitalisation and meds, and finally considered the
prognosis. Generally good with treatment,
but also the high recurrence risk and the serious
complications if left untreated.I think the core takeaway here

(18:25):
is pretty clear. PPP is rare, yes, but it's a
genuine psychiatric emergency needing urgent help.
Well, it's incredibly challenging.
With the right timely treatment,recovery is generally the
expected outcome. But being aware of that
significant recurrence risk, especially in future
pregnancies, is absolutely essential for ongoing care and
planning. Yeah, it may be a final thought
to leave people with thinking about.

(18:46):
How those really? Rapid, profound, biological.
Shifts after birth. How they can intersect with
underlying vulnerabilities to trigger such a severe mental
health crisis. It just powerfully highlights
that deep connection between ourphysical state, our hormones and
our psychological well-being. And maybe more practically, it
really emphasises how vital it is for families, partners,
friends and all healthcare providers to be vigilant.

(19:09):
To recognise the signs in a new mother and know when to seek
urgent help, not just dismiss significant changes as baby
Blues or normal tiredness. Early action makes all the
difference. Well, that's a really powerful
and important thought to end on.Thank you for joining us for
this deep dive unpacking your notes on postpartum psychosis.
For those of you using this for revision, maybe for the MSRA or

(19:31):
other exams, or just wanting to expand your understanding, we
really hope this has been a highyield session for you.
Remember, this deep dive was built using the resources
mentioned in your notes. You can find more resources and
specific revision materials, especially if you're preparing
for exams like the MSRA over at Pass Them sayaparade.com.
And also definitely check out the free resources available at
freesra.com. Lots of good stuff there too.

(19:54):
Thanks for listening, until nexttime.