Postpartum psychosis is a severe, but treatable, psychiatric condition that affects 1-2 of every 1000 mothers shortly after childbirth. Evidence suggests that the condition is precipitated by a combination of biological and environmental factors.

Whilst it is a rare condition, it is a devastating mental health problem that usually affects women in the first few weeks after giving birth. Symptoms can include delusional thoughts, mood swings, visual or auditory hallucinations, insomnia, and hyperactivity.

Currently, there are no procedures to help identify women who might go on to develop postpartum psychosis, except for estimated risk due to a history of bipolar or a schizoaffective disorder or women who have suffered a previous episode of psychosis.

Moreover, the biological markers of how different brain areas communicate to each other in postpartum psychosis have so far remained a mystery.

However, a team of researchers from the Institute of Psychiatry, Psychology, & Neuroscience at King’s College London, and the University of Padova in Italy, have identified key areas of altered connectivity in brain networks that are suggestive of risk of postpartum psychosis.

Goal-directed behaviour was shown to be an indicator of postpartum psychosis

The study examined brain scans of 32 women known to be at risk from symptoms and 27 other women with no identified risk. These women were followed up from pregnancy through to eight weeks after giving birth. In the first four weeks after delivery, 15 women became unwell with symptoms indicating postpartum psychosis.

To analyse what brain networks may be differentially activated, the women eight weeks after giving birth had brain scans comparing their brain at rest and during an emotional processing task. The task involved the participants identifying the emotions expressed in images of faces, with the researchers timing the participants for how long they took to recognise the correct emotion.

All the women at risk of postpartum psychosis, especially the women who became unwell, struggled more with making sense of negative emotions than the other women. Which the researchers said suggest reduced connectivity between specific brain networks.

Potentially reflecting the emotional insecurity of the women who were experiencing symptoms, the researchers said that the areas of the brain involved in planning, organising, and completing tasks or networks associated with goal-directed behaviour were substantially altered and affected.

Professor Paola Dazzan, King’s College London, commented that understanding the markers of vulnerability for symptoms is a step in the right direction to explain why some women are more vulnerable than others. But also, in terms of treatment of support, demonstrating areas of the brain that can offer clues to the likelihood of developing symptoms can enable earlier interventions and treatment.

She added: “If subtle alterations in the brain’s executive network, and its interaction with other brain areas, were also detectable in pregnancy, these could offer vital clues to the development of postpartum psychosis. Potentially, this could enable us to intervene earlier, allowing clinicians to provide the best possible support for new mothers, before the onset of symptoms.”