Picture2“…there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns – the ones we don’t know we don’t know.”

Known knowns…

  • Postpartum / puerperal psychosis: 1 to 2 in 1000 – around 50% are first episodes
  • Onset is very soon after childbirth, first two weeks is typical
  • Duration: weeks – months (although feeling ‘fully recovered’ often years)
  • Symptoms: severe affective psychosis, mood symptoms, mixed, perplexity
  • Rapidly progressing & changing picture, “kaleidoscopic”
  • Treatment: – psychiatric emergency, medication, admission
  • Women with a previous postpartum psychosis or bipolar disorder at very high risk
  • Childbirth is a powerful trigger – not due to changing medication

Known unknowns…

  • Need more information about the safety of medications in pregnancy
  • Need to know more about how to discuss risk
  • Need to know more about the causes of postpartum episodes
  • Need to know how to help women stay as well as possible

Unknown unknowns…

“I would not say that the future is necessarily less predictable than the past. I think the past was not predictable when it started.”