276: Postpartum Psychosis: Symptoms, Warning Signs, Risk Assessment, and Treatment with Dr. Furey and Dr. Puder

August 21, 2026

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5 min read

Postpartum Psychosis: What Clinicians Need to Know

Postpartum psychosis is a severe psychiatric emergency that develops in about 1–2 per 1,000 live births—roughly as common as Down syndrome, which translates to 3,000–4,000 women per year in the United States. Yet it has no formal diagnostic criteria in the DSM-5, which Dr. Katrina Furey, a Yale-trained reproductive psychiatrist, calls "the first problem when it comes to identifying and treating postpartum psychosis." Without a shared diagnostic framework, the condition is easy to miss, especially in its subtler presentations.

Recognizing the Signs Beyond the Obvious

Classic postpartum psychosis typically emerges within 24 hours to three weeks after delivery, with average onset around day eight. Some experts advocate extending that window to 12 weeks, and a 2025 consensus statement has urged the DSM to do so. The symptoms include delusions, hallucinations, paranoia, and mood symptoms like anxiety, irritability, restlessness, and a decreased need for sleep.

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What you'll learn

1 (01:14) **What Is Postpartum Psychosis?** - Defining the condition, its diagnostic ambiguity, and the typical onset window.
2 (03:28) **Core Symptoms: Delusions** - Exploring the content and presentation of delusional beliefs in postpartum psychosis.
3 (07:43) **Differentiating Psychosis from Postpartum OCD** - A practical breakdown of how to distinguish ego-dystonic intrusive thoughts from psychotic beliefs.
4 (11:07) **The Role of Irritability and Inner Restlessness** - How to interpret nonspecific symptoms that can signal the onset of psychosis.
5 (14:44) **Filicide: Risk, Rarity, and Predictive Challenges** - Discussing the actual risk of harm and the limitations of current prediction models.
6 (15:49) **Key Findings from a Filicide Cohort Study** - Dr. Puder reviews specific data differentiating neonaticide from infanticide.
7 (22:55) **The "Quiet" High-Risk Patient** - Warning against overlooking the depressed, preoccupied patient who may be at great risk.

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Show Notes

In this essential episode, Dr. David Puder sits down with board-certified reproductive psychiatrist Dr. Katrina Furey to unpack postpartum psychosis. They cover its early warning signs, symptoms, diagnostic challenges, risk assessment, and evidence-based treatment. They discuss classic onset within days to weeks after delivery, common delusions centered on the infant, fluctuating mental status, the critical distinction from postpartum OCD, elevated risks of filicide and suicide, strong links to bipolar spectrum disorders, and the vital roles of lithium, antipsychotics, sleep protection, ECT, medical workup, and family support. Learn why this psychiatric emergency demands rapid intervention, how most women fully recover, and practical guidance for clinicians and families navigating this rare but treatable condition.

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