This disorder is distinct from post-partum or post-natal depression and should not be referred to as such. It occurs in 1 to 2 in 1000 childbearing women within the first 2 to 4 weeks after delivery. It most commonly presents as a manic psychosis but also as severe psychotic depression or an acute polymorphic psychosis (40) and a history of bipolar affective disorder is a major risk factor (25,26,28,46). It is characterised by a rapid onset; paranoid, grandiose or bizarre delusions; mood swings; confused thinking; and disorganized behaviour that represents a dramatic change from previous functioning (47). Symptom clusters that precede onset of psychosis include feeling excited, elated or high, not needing to sleep or not able to sleep and feeling very active or energetic. There is a high and specific heritability (25,28) and a recurrence rate is 1 of every 4 subsequent pregnancies (48).