• Medical disorders: pelvic infections, thromboembolism, and other physical complications of childbirth, although not common nowadays, need to be excluded in every case. The clinical picture would in this case be one of delirium - in other words, it would be an organic psychosis. In early cases, the defining feature of confusion, reduced conscious level, may be apparent only on detailed cognitive testing.

• Hormone changes: it is speculated that the abrupt fall in oestrogen and progesterone concentrations that occurs after delivery might precipitate psychosis in predisposed women.

• Psychosocial stress: childbirth as a major 'life event' could precipitate psychosis in predisposed women.

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