Sep 18, 2026 · 52 min
Postpartum psychosis demands faster diagnosis and prevention
Postpartum Psychosis: Diagnosis, Treatment, Lithium, and Relapse Prevention with Dr. Veerle Bergink
Postpartum psychosis can be treatable and preventable, but outcomes depend on recognizing medical mimics, acting quickly, and planning beyond the acute crisis.
- 1Clinicians must distinguish postpartum psychosis from anti-NMDA receptor encephalitis, thyroid disease, and medication-related movement symptoms.
- 2Lithium is underused for relapse prevention despite guideline support and evidence of substantially lower recurrence with lithium and antipsychotics.
- 3Mother-baby inpatient units and a distinct DSM diagnosis could improve continuity, family outcomes, and access to specialized care.
Don't miss
Bergink's closing prevention message argues that women at high risk can often reduce recurrence by starting medication immediately after delivery.
The brief
Veerle Bergink and David Puder begin with a postpartum case that moves from insomnia and irritability toward mania or psychosis, forcing rapid assessment and inpatient care.
The differential diagnosis is urgent: rigidity, tremor, or bradykinesia after antipsychotic treatment should prompt evaluation for anti-NMDA receptor encephalitis, while thyroid disease can complicate recovery.
Bergink describes high recovery rates but a serious recurrence risk, with roughly half of women remaining well until a later pregnancy or delivery and clinical presentations varying widely.
Lithium emerges as the prevention debate's central tension: guidelines support it, evidence suggests markedly lower relapse, yet clinicians underuse it and the data are nonrandomized.
The episode's practical endpoint is mother-baby care and prevention: dedicated units can keep infants with hospitalized mothers, while immediate postpartum medication can reduce recurrence risk.