AMNA NAWAZ: The murder trial of Massachusetts mother Lindsay Clancy has brought renewed attention to mental health issues, and specifically a condition known as postpartum psychosis, a rare but severe mental health condition.

Our Stephanie Sy has more.

STEPHANIE SY: That's right, Amna.

Lindsay Clancy is on trial for killing her three children in 2023.

Her now ex-husband found the children strangled in the basement and Clancy injured from an apparent suicide attempt.

All the children were under the age of 5.

And Clancy is now paralyzed from the waist down.

Her defense lawyer says she was experiencing postpartum psychosis, which can cause delusions.

But prosecutors are charging that she acted intentionally.

SHANAN BUCKINGHAM, Massachusetts State's Attorney: This was a woman who acted intentionally, rationally, and swiftly to accomplish a very specific goal, to kill.

KEVIN REDDINGTON, Attorney For Lindsay Clancy: This is a woman that did not get the medication, did not get the medical treatment that she so deserved.

This was a woman that was suffering from psychosis at the time that she went down to that basement.

STEPHANIE SY: Postpartum depression is not uncommon, but postpartum psychosis affects only about one in 1,000 women.

For more, we're joined now by Dr.

Julia Riddle, a psychiatrist who focuses on reproductive mental health at the University of North Carolina Center for Women's Mood Disorders.

Dr.

Riddle, thank you so much for joining the "News Hour."

How much do we know about postpartum psychosis and who it is most likely to afflict?

DR.

JULIA RIDDLE, UNC Center for Women's Mood Disorders: Yes, thank you, Stephanie.

The truth is, we don't know enough.

We need so much more research and so much more attention.

But what we do know, which we have gotten from some registry studies, some Danish registry studies, as well as our own research, is that the people that are highest risk -- as you mentioned, so it's about one to two in 1,000 -- highest risk seems to be associated with bipolar disorder, because this is an affective disorder, which means a mood disorder.

So women with bipolar disorder or a history of postpartum psychosis are at the highest risk.

But it's not everybody with bipolar disorder, and there are women who their first episode with any mental health condition will be in the postpartum.

So other indicators for that may be a difficult delivery, losing a lot of sleep, OK, or having family members, so family members that have had postpartum psychosis or a family history of bipolar disorder, going back to that being the highest risk.

So we don't always know who they are, OK, and we don't always know exactly who to follow, but those are some of our indicators, which does make it a really difficult disease to prevent.

STEPHANIE SY: Describe the typical experience of a woman having an episode of postpartum psychosis.

DR.

JULIA RIDDLE: Yes, absolutely.

So, first and foremost, right, people never read the textbook, so I will do my best to describe this.

It is considered usually rapid, so very, very soon after delivery.

So, a woman gives birth, and usually it's within the first few weeks, family will notice a change.

They're acting odd.

They don't seem with us.

They're a little more detached, or they're more irritable and agitated.

So it often looks like confusion, an agitated state or a manic state, so extra energy, not sleeping being one of the most worrying signs.

So you tell them to go lay down and they cannot sleep.

You find them pacing.

You find them moving things in an odd way.

It doesn't quite make sense.

This often gets so normalized because, if it's the first child, who knows what it's supposed to be like?

So, irritability, excitability, or it can look like a deep and detached depression.

When it starts to get really scary, and we often talk about this in what we do, it's almost as if a vacancy comes over them.

And this is often when we see a loss of reality.

So when there these delusions start, delusions that the world is not safe, delusions that they have to do something to change things for themselves, this is when we start to really worry about thoughts of suicide in particular, and sometimes when some of these infanticide thoughts can come up.

So it can progress, but usually it's this rapid change in the way the woman behaves.

But often she's not sharing it.

So people are kind of watching and wondering.

STEPHANIE SY: It sounds terrifying, but isn't it also true that most women who have this do not exhibit violence?

DR.

JULIA RIDDLE: That is absolutely true.

And I really want to put a point on that, OK?

In the media right now, the number that's getting quoted is 4 percent.

So we're talking about one to two in 1,000 women after birth having postpartum psychosis and then 4 percent of that.

That's actually a misattribution of a citation.

What it is looking at with that, what that paper was looking at was actually only women with a depressed version of psychosis, so they got depressed, so depressed that they became psychotic.

And that was the group at 4 percent risk.

So we're not even talking about that one to two out of 1,000.

We're talking about a small, small, small group.

So it is rare.

This is a treatable illness.

When this gets recognized and treated, women get better, and the vast majority, the vast, vast majority are not violent.

STEPHANIE SY: During Lindsay Clancy's trial, a handwritten log she kept was presented, Dr.

Riddle.

She lists several psychiatric medications in this log and wrote at one point: "Awake all night with suicidal ideation."

She was apparently aware that she needed medical intervention.

How challenging is it for patients to find a psychiatrist who can properly diagnose and treat postpartum psychosis?

DR.

JULIA RIDDLE: Hard.

The answer is hard.

This is not part of psychiatric training, N.P.

training, P.A.

training, psychology, or social work training.

This is not something that is currently required as part of our education.

So I sit on the board for the National Curriculum on Reproductive Psychiatry, because we know people are hungry for this education, but it is not required.

So it is hard for a patient to know when they're seeing someone that has the appropriate training.

But it's also hard as a trainee or someone practicing to get these -- to get this training.

So if we're not finding the right diagnosis, we're not providing the right treatment, and that's a real problem.

STEPHANIE SY: Thankfully, these tragedies are very rare.

But what do you hope comes out of these discussions, not only on postpartum psychosis, but on postpartum mental health?

DR.

JULIA RIDDLE: Great question.

What I really hope for is better training for both -- for our professionals.

I also hope for better recognition, reduction of stigma, and really more investment in our research.

When we look at the research that goes into women's health, it is 6 percent of the investment.

Women deserve so much more, because, when we can get women and families better, right,we get mom better, we take care better of baby family, the whole family unit, and that has reverberations into the community and honestly into the economy.

So these things matter tremendously.

What I also want people to know is that these are treatable illnesses, whether it's postpartum depression, postpartum anxiety and OCD, or postpartum psychosis.

There are treatments and people do get better.

STEPHANIE SY: That is psychiatrist Julia Riddle with the University of North Carolina.

Thank you so much for sharing your expertise.

DR.

JULIA RIDDLE: Thank you.