Postpartum psychosis signs: a short emergency checklist for family, and where to go in Singapore at any hour

Postpartum psychosis is rare, but it is an emergency. SingHealth says it affects about 0.1% of women who have just given birth, roughly 1 in 1,000, and usually starts within the first two weeks. The signs to act on are a new mum losing touch with reality, sudden and dramatic mood changes, confusion, and seeing, hearing or believing things that aren't real. If you notice them, don't wait to see if they pass. Call 995 if anyone is in danger, or take her to the nearest hospital A&E or to IMH's 24-hour Emergency Services today, and don't leave her alone with the baby until a doctor has seen her.

The signs to act on

SingHealth's perinatal depression guide, written by KKH's Women's Mental Wellness Service, lists the symptoms of postnatal psychotic depression as a loss of touch with reality, dramatic mood changes, confusion, hallucinations and delusions. In everyday terms, family usually notice things like these:

• She says or believes things that make no sense, or that nobody else shares, such as being sure the baby is not hers, is in danger from a relative, or has special powers
• She hears voices or sees things that aren't there
• She seems confused, doesn't know the time or place, or can't follow a simple conversation
• Her mood swings hard, from very high, fast-talking and restless to tearful, frightened or flat, sometimes within hours
• She hardly sleeps, even when the baby is asleep and someone else is on duty
• She becomes suspicious of family or hospital staff, or withdraws completely
• She behaves in ways that are out of character and that she can't explain

HealthHub notes that before the clearer symptoms of psychosis appear, people often show earlier changes: feeling that things around them have changed, anxiety, mood swings, irritability, suspiciousness, poor concentration, and changes in sleep and appetite. After a birth, some of that looks like ordinary exhaustion, which is why the question to ask is whether she still seems like herself. If she doesn't, get her seen the same day.

One more difference matters. A mum with postpartum anxiety or OCD may have frightening thoughts about the baby, but she knows they are irrational and they horrify her. In psychosis, she may not see that anything is wrong. Our guide to postpartum anxiety covers the thoughts that are distressing but not psychosis.

An emergency checklist for family

Print this and keep it with the hospital bag, or save it on your phone. It is written for a partner, parent or helper who is with her when the signs start.

Where to go in Singapore, at any hour

These are the routes that are open around the clock, plus the specialist services that take over once she is safe. SingHealth describes postpartum psychosis as a psychiatric emergency that usually needs a hospital stay, so the emergency routes come first.

You don't need a referral to walk into an A&E or IMH Emergency Services. On arrival, IMH says staff screen and register you, tell you the estimated wait, and see the most urgent cases first.

How it differs from the baby blues and postnatal depression

All three can start in the first weeks, so families mix them up. SingHealth puts the baby blues at up to two in three mums in the first week; it settles within days to a couple of weeks. Postnatal depression affects 10 to 15% of mums, usually within three to six months. Psychosis is the rarest and the most urgent.

If her mood is low but she is in touch with reality, read our guide to postnatal depression in Singapore, which covers screening, costs and treatment.

What happens in hospital, and recovery

SingHealth says hospital admission is usually needed, because the illness carries a high risk of self-harm and of harm to the baby. Doctors first work out the cause. SGH's psychiatry team explains that psychosis is a symptom, not an illness in itself, and that blood tests or brain scans may be done to rule out a physical cause before treatment. NUH notes that a brief psychotic episode can follow a major stressor, and lists childbirth among them, and that treatment includes medication.

SingHealth says the chance of recovery is good with early recognition and treatment, and that close follow-up is needed afterwards. What family can do while she recovers:

• Take over the baby's night care so she can sleep, and keep the house quiet and predictable
• Go with her to follow-up appointments, and write down what the doctor says
• Ask the treating team before she restarts breastfeeding or expressing, because it depends on her medicine; KKH says some treatments for perinatal mental illness are compatible with breastfeeding
• Feed the baby expressed milk or formula in the meantime; our guide to mixed feeding explains how to protect her supply if she wants to continue
• Don't talk about what happened as her fault; it is an illness, and she will need reassurance more than questions

Planning a next pregnancy

SingHealth warns that postpartum psychosis can come back in a later pregnancy in as many as 70% of women, so close follow-up matters. If she has had it before, tell the O&G early in the next pregnancy, ideally before trying. HealthHub also lists a family history of psychotic illness as a risk factor for psychosis, so mention that too. KKH's Women's Mental Wellness Service and NUH's Women's Emotional Health Service both see women in pregnancy, and a plan made in advance means help is ready the moment it's needed. For the wider picture of planning another child, see our guide to family planning in Singapore.

Frequently asked questions

What are the first signs of postpartum psychosis?

Often sleeplessness, restlessness, confusion, suspiciousness or a sudden change in mood, followed by beliefs or perceptions that aren't real. SingHealth lists loss of touch with reality, dramatic mood changes, confusion, hallucinations and delusions. If she doesn't seem like herself, get her seen the same day.

How soon after birth does postpartum psychosis start?

SingHealth says it usually surfaces within the first two weeks after delivery, which is often while she is still recovering from the birth at home or in confinement.

How common is postpartum psychosis?

Rare. SingHealth puts it at about 0.1% of women who have just given birth, roughly 1 in 1,000, compared with 10 to 15% for postnatal depression.

Should I call 995 or go to A&E?

Call 995 if she might harm herself or the baby, or you can't get her to hospital safely. Otherwise, go straight to the nearest A&E or IMH Emergency Services, both open 24 hours. Don't wait for a clinic appointment.

Can a mum recover from postpartum psychosis?

Yes. SingHealth says the chance of recovery is good with early recognition and treatment, which usually starts in hospital. Follow-up continues after discharge, and SingHealth advises close monitoring because it can return in a later pregnancy.

Is postpartum psychosis the same as postnatal depression?

No. SingHealth describes it as the most severe form of postnatal mood illness, with symptoms such as hallucinations and delusions that postnatal depression doesn't have. Postnatal depression is far more common and is usually treated as an outpatient.