Psychosis in women

Mary V. Seeman, MD, Professor emerita, Department of psychiatry, University of Toronto

Psychoses of unknown cause usually begin in late adolescence or early adulthood. Less frequently the onset occurs in later adulthood (age ≥40). Late-onset psychosis is much more prevalent in women than in men for reasons that are imperfectly understood.

When you are evaluating a midlife woman with first onset of psychosis, don’t assume an illness of unknown cause (bipolar disorder or schizophrenia) until after you have done a comprehensive search for triggers of her psychotic symptoms. After age 40, women are more likely than men to develop psychosis because of gender-specific medical and psychological precipitants.

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Postpartum psychosis: Strategies to protect infant and mother from harm

Susan Hatters Friedman, MD
Senior instructor, Departments of psychiatry and pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH

Phillip J. Resnick, MD
Professor, Department of psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH

Miriam B. Rosenthal, MD
Associate professor emeriti, Departments of psychiatry and obstetrics and gynecology, Case Western Reserve University School of Medicine, Cleveland, OH

Postpartum psychosis (PPP) presents dramatically days to weeks after delivery, with wide-ranging symptoms that can include dysphoric mania and delirium. Because untreated PPP has an estimated 4% risk of infanticide (murder of the infant in the first year of life), and a 5% risk of suicide, psychiatric hospitalization usually is required to protect the mother and her baby.

The diagnosis may be missed, however, because postpartum psychotic symptoms wax and wane and suspiciousness or poor insight cause some women—such as Andrea Yates—to hide their delusional thinking from their families. This article discusses the risk factors, prevention, and treatment of PPP, including a review of:

• infanticide and suicide risks in the postpartum period

• increased susceptibility to PPP in women with bipolar disorder and other psychiatric disorders

• hospitalization for support and safety of the mother and her infant.

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