Postpartum psychosis is a medical emergency. So when an obstetrician calls me or a pediatrician calls me and says, “I have this new mother in my office. She was totally normal during her pregnancy; she is acting really strange. Her husband hasn’t been able to go to work because she won’t sleep, she has all sorts of strange ideas about the baby, and the baby’s special powers, and how the baby is influencing her,” anything that sounds, again, psychotic, out of touch with reality, more than just, “I'm overwhelmed; I am crying; I can’t sleep.” Those individuals are of extreme concern. Those are individuals who should not be responsible for the care of their baby without supervision, and those are individuals whose condition is likely to spiral down into a full-blown psychotic episode where they may become dangerous to themselves or to others, clearly unable to care for themselves.
So those individuals need to be seen in a hospital emergency room, not in a doctor’s office, and typically new mothers with postpartum psychosis should be admitted to the hospital for at least a brief period of observation and stabilization where you can sort of tease out what is the underlying disorder. Is this somebody with a previous psychiatric history who has been off their medication and is now getting worse? Is this somebody who for the first time is having psychotic symptoms? But I think, we tend to err on the side of what we think is generous and empathic to a new mother who is experiencing this kind of psychiatric distress, not to hospitalize her, not to put her in a hospital with crazy people, not to separate her from her baby, but we’re not doing patients a favor. There are so many stories of under-diagnosed or sort of inadequate interventions for new mothers with postpartum psychosis where the outcome is tragic.
About Dr. Nehama Dresner, M.D.:
Dr. Nehama Dresner, M.D., is a licensed, Board-certified psychiatrist (in general psychiatry and psychosomatic medicine) with specialized training and nearly 20 years experience in Women's Mental Health and Medical Psychiatry. She is Associate Professor of Clinical Psychiatry and Obstetrics/Gynecology at Northwestern University Feinberg School of Medicine and is actively involved in medical education. A fellow in the Academy of Psychosomatic Medicine and the America Psychiatric Association, she speaks locally and nationally on issues related to psychological aspects of women's health and medical psychiatry. Dr. Dresner's clinical specialty is psychosomatic obstetrics, and gynecology, women's emotional development, and psychiatric treatment of the medically ill.