Recent literature suggests that, more frequently, this syndrome occurs in the context of known or new-onset bipolar illness (see Postpartum Bipolar Disorder). Given the variety of symptoms associated with PPP, a thorough consideration of other psychiatric and non-psychiatric (or organic) causes should be ruled out through a combination of diagnostic labwork and imaging, as well as clinical presentation - a non-exhaustive sample of these other causes is examined below (see Organic postpartum psychoses and Other non-organic postpartum psychoses). Clinical Presentation By diagnostic definition (Brief psychotic disorder with peripartum onset), PPP occurs either during pregnancy or within 4 weeks of delivering the infant. Generally, PPP symptoms have been observed within 3–10 days of childbirth, though women with a past history of bipolar disorder may experience symptoms even sooner. The persistence of symptoms varies; while the average reported length of an episode may last weeks to several months, there is currently no strong literature documenting the course of individual episodes. Recurrence rates for psychotic episodes, on the other hand, have stronger supporting studies and are covered in more detail below (see Prognosis and Outcomes). Diagnostic criteria per the DSM-V requires the presence of at least one psychotic symptom, defined as delusions, hallucinations, bizarre or incoherent speech (disorganized speech), or abnormal movements (psychomotor behavior), such as catatonia. Delusions, particularly about the infant, are the most commonly reported psychotic symptom associated with PPP. Paranoid delusions are a frequently noted theme in cases of PPP, but a small review noted infrequent cases of delusional misidentification syndromes, such as Capgras syndrome (the belief that someone or something familiar has been replaced with an imposter), Fregoli syndrome (the belief that a stranger is actually a known person in disguise), and others. The latter types of delusions may have a significant negative impact on the bond between a mother and child, raising concerns for the safety of both (see Prognosis and Outcomes). Both postpartum obsessive-compulsive disorder (OCD) and PPP may present with concerning thoughts about the infant: typically, the thoughts associated with OCD are unwanted and distressing to the individual (who does not wish to act on their thoughts) where persons with PPP are often not as distressed by their beliefs and may even feel the need to act on their beliefs. Delusions associated with PPP tend to be less bizarre than those more frequently seen in patients with schizophrenia, and hallucinations, when present, tend to be more