Red flags « PATH

1. Where there is a history of mental illness

In women with Bipolar Affective Disorder, there is:

More than one in five risk of suffering from postnatal psychosis.
Almost one in two risk of experiencing severe postnatal depression
One in two risk of postnatal psychosis for women with a history of previous postnatal psychosis

These women should be referred to a community mental health team, preferably a specialist perinatal in pregnancy, even if they are well, so a personalised care plan can be made.

In women with severe depression:

There is a 40% risk of subsequent postnatal and non-postnatal relapse

2. Postpartum psychosis

It is a psychiatric emergency and requires specialist assessment and treatment within 4 hours
50% of women who get postnatal psychosis have no history of mental health problems

3. Presentations which should prompt urgent senior psychiatric assessment

Recent significant change in mental state or emergence of new symptoms
New thoughts or acts of violent self-harm
New and persistent expressions of incompetency as a mother or estrangement from the infant

References

Jones et al Lancet series on Perinatal Mental Illness (2014)Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period.