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PubMed This is a summary of 14 peer-reviewed journal articles Updated
Psychiatry

Medical Look-Alikes: Ruling Out Physical Causes

At a Glance

Before diagnosing postpartum psychosis, doctors must rule out physical illnesses that mimic psychiatric emergencies. Conditions like anti-NMDAR encephalitis or postpartum thyroiditis require specific medical treatments. Families should advocate for a full medical workup, including thyroid tests.

This section is written for the partner, family, or caregiver of the patient.

When a person experiences a break from reality after giving birth, the diagnosis is often assumed to be postpartum psychosis (PPP). However, because PPP is a rare condition, it is critical to ensure that other medical illnesses aren’t “mimicking” the symptoms [1]. This is especially important for women with no previous history of mental health struggles [2].

In some cases, the psychiatric symptoms are the brain’s way of reacting to a physical illness elsewhere in the body.

The Critical Rule-Out: Anti-NMDAR Encephalitis

The most serious medical look-alike is Anti-NMDAR Encephalitis, a condition where the body’s immune system mistakenly attacks the brain [3]. While it looks like a psychiatric crisis, it is a life-threatening neurological emergency.

  • Why it mimics PPP: It can cause sudden delusions, hallucinations, insomnia, and severe anxiety [4].
  • The “Red Flags”: Unlike standard PPP, this condition typically includes physical symptoms like unexplained fevers, seizures, or autonomic instability (rapidly shifting heart rate or blood pressure) [5][3].
  • The Ovarian Link: In many women, this immune reaction is triggered by an ovarian teratoma — a small, often benign tumor on the ovary [6]. Removing the tumor and treating the immune system can lead to a full recovery [7].

Endocrine Triggers: Postpartum Thyroiditis

The thyroid gland regulates the body’s energy and mood. After birth, some women experience postpartum thyroiditis, an inflammation of the thyroid that can cause massive swings in hormone levels [8].

  • Thyroid Storm: A sudden surge in thyroid hormones can cause a “manic” state, including racing thoughts and psychosis [9].
  • Hypothyroidism: Conversely, a sudden drop in thyroid function can cause profound depression and “myxedema madness,” a form of psychosis triggered by low hormone levels [10].

Other Potential Causes

Beyond the brain and the thyroid, doctors should consider several other “organic” (physical) causes for new-onset psychosis:

  • Pre-eclampsia/Eclampsia: High blood pressure during or after pregnancy can cause brain swelling (edema) that leads to confusion and psychotic symptoms [11].
  • Infection: Severe infections (sepsis) or a urinary tract infection can cause delirium that looks like psychosis, particularly if the mother is very physically weak.
  • Vitamin Deficiencies: Severe lack of Vitamin B12 or Vitamin D can impair brain function and mood [12].

Recommended Medical Tests

If your partner has no prior psychiatric history, you should advocate for a “medical workup” to ensure a physical cause isn’t being missed. You may ask the doctor about the following:

Category Recommended Tests Why It’s Needed
Endocrine TSH, Free T4, T3 To rule out thyroid dysfunction [13].
General CBC, Metabolic Panel, Urinalysis To check for infection or electrolyte imbalances [2].
Imaging Brain MRI & Pelvic Ultrasound To look for brain inflammation or ovarian tumors [6].
Autoimmune Lumbar Puncture (Spinal Tap) Only indicated if physical “red flags” (fever, seizures, autonomic instability) are present. Used to check for Anti-NMDAR antibodies in the spinal fluid [14].

Ensuring these basic tests are considered can provide peace of mind that the treatment being provided is addressing the true root of the crisis.

Common questions in this guide

What medical conditions can mimic postpartum psychosis?
Several physical illnesses can cause symptoms that look like postpartum psychosis. These include anti-NMDAR encephalitis, postpartum thyroiditis, severe infections, and complications from pre-eclampsia.
What are the red flags for anti-NMDAR encephalitis?
Unlike typical postpartum psychosis, anti-NMDAR encephalitis often presents with physical warning signs. These "red flags" include unexplained fevers, seizures, and rapidly shifting heart rate or blood pressure.
Can thyroid problems cause psychotic symptoms after giving birth?
Yes, postpartum thyroiditis can cause massive hormone swings. A sudden surge in thyroid hormones can lead to a manic state with racing thoughts, while a sudden drop can cause profound depression and psychosis.
What tests should a doctor run to rule out physical causes of postpartum psychosis?
Doctors typically run a complete blood count, metabolic panel, and thyroid panel to check for basic imbalances. Depending on the physical symptoms, they may also recommend a brain MRI, pelvic ultrasound, or a spinal tap.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given that she has no prior psychiatric history, what steps are being taken to rule out medical causes like autoimmune encephalitis or thyroid issues?
  2. 2.Has a neurologist been consulted to evaluate her for signs of 'autonomic instability,' such as her fluctuating heart rate or blood pressure?
  3. 3.Can we run a full thyroid panel, including TSH and Free T4, to check for postpartum thyroiditis?
  4. 4.If she is showing physical symptoms like fever or seizures, is a lumbar puncture recommended to check for Anti-NMDAR encephalitis?
  5. 5.Are her psychiatric symptoms being treated as a primary mental health issue, or are we looking for 'organic' triggers in her blood work?

Questions For You

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References

References (14)
  1. 1

    Recurrent Postpartum Psychosis With Delayed Onset and Rapid Recovery: A Case Report.

    Jacobsen G, Saffioti A, Cortes EY, Padilla VL

    Cureus 2025; (17(5)):e84506 doi:10.7759/cureus.84506.

    PMID: 40546624
  2. 2

    Puerperal psychosis: an update.

    Baldaçara L, Leite VDS, Teles ALS, Silva AGD

    Revista da Associacao Medica Brasileira (1992) 2023; (69(suppl 1)):e2023S125 doi:10.1590/1806-9282.2023S125.

    PMID: 37556644
  3. 3

    Anti-NMDA receptor encephalitis presenting as postpartum psychosis-a clinical description and review.

    Reddy MSS, Thippeswamy H, Ganjekar S, et al.

    Archives of women's mental health 2018; (21(4)):465-469 doi:10.1007/s00737-018-0816-3.

    PMID: 29417305
  4. 4

    Practice Current: How do you treat anti-NMDA receptor encephalitis?

    Bartolini L

    Neurology. Clinical practice 2016; (6(1)):69-72 doi:10.1212/CPJ.0000000000000219.

    PMID: 29443234
  5. 5

    Anaesthetic management of a patient with a unique combination of anti-N-methyl-D-aspartate receptor encephalitis and stiff-person syndrome.

    Gharedaghi MH, Khorasani A, Knezevic NN, Ebrahimi F

    BMJ case reports 2018; (2018()) doi:10.1136/bcr-2017-223261.

    PMID: 29735495
  6. 6

    Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report.

    Abdul-Rahman ZM, Panegyres PK, Roeck M, et al.

    Journal of medical case reports 2016; (10(1)):296 doi:10.1186/s13256-016-1067-4.

    PMID: 27776544
  7. 7

    Postpartum Anti-N-methyl-D-aspartate Receptor Encephalitis: A Case Report and Literature Review.

    Doden T, Sekijima Y, Ikeda J, et al.

    Internal medicine (Tokyo, Japan) 2017; (56(3)):357-362 doi:10.2169/internalmedicine.56.7442.

    PMID: 28154283
  8. 8

    Thyroid dysfunction following pregnancy and implications for breastfeeding.

    Amino N, Arata N

    Best practice & research. Clinical endocrinology & metabolism 2020; (34(4)):101438 doi:10.1016/j.beem.2020.101438.

    PMID: 32651061
  9. 9

    Acute Psychosis and Suicidal Attempt in Hashimoto's Thyroiditis: A Case Report.

    Bokhari SA, Alramahi G, Abulmagd M, Alabrach N

    Cureus 2024; (16(10)):e71421 doi:10.7759/cureus.71421.

    PMID: 39539911
  10. 10

    Myxedema Psychosis: Systematic Review and Pooled Analysis.

    Mohamed MFH, Danjuma M, Mohammed M, et al.

    Neuropsychiatric disease and treatment 2021; (17()):2713-2728 doi:10.2147/NDT.S318651.

    PMID: 34447249
  11. 11

    Pre-eclampsia and first-onset postpartum psychiatric episodes: a Danish population-based cohort study.

    Bergink V, Laursen TM, Johannsen BM, et al.

    Psychological medicine 2015; (45(16)):3481-9 doi:10.1017/S0033291715001385.

    PMID: 26243040
  12. 12

    Sexual Functioning and Depressive Symptoms in Levothyroxine-Treated Women with Postpartum Thyroiditis and Different Vitamin D Status.

    Kowalcze K, Kula-Gradzik J, Błaszczyk A, Krysiak R

    Nutrients 2025; (17(13)) doi:10.3390/nu17132091.

    PMID: 40647196
  13. 13

    Non-reproductive triggers of postpartum psychosis.

    Brockington I

    Archives of women's mental health 2017; (20(1)):55-59 doi:10.1007/s00737-016-0674-9.

    PMID: 27722949
  14. 14

    Catatonia: American Psychiatric Association Resource Document.

    Wilson JE, Oldham MA, Francis A, et al.

    Journal of the Academy of Consultation-Liaison Psychiatry 2025; (66(4)):277-299 doi:10.1016/j.jaclp.2025.05.001.

    PMID: 40368005

This page provides educational information about medical conditions that can mimic postpartum psychosis. It does not replace professional medical advice. Always consult a healthcare provider immediately if you or a loved one is experiencing a psychiatric or medical emergency.

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