visual than auditory (compared to schizophrenia which is often associated with auditory hallucinations). The sensation of being outside one's body or feeling that your surroundings are unreal (i.e., derealization) has also been described in cases of PPP. Additional distinctions in PPP compared to classical schizophrenia include the presence of mood and cognitive (or neurological) symptoms. Rapid mood changes or the presence of abnormal moods such as depression or mania (increased energy, decreased need for sleep, etc.) tend to be seen in a large percentage of patients experiencing PPP. Irritability, anxiety, and general difficulties with sleep may also be present. Confusion or disorientation, disorganized thoughts, incoherent speech, or abrupt changes in a person's mental capacity may also be seen in individuals experiencing PPP, though one small study observed these neurological symptoms in only one-quarter of PPP cases. Like delirium, these symptoms may come and go in unpredictable patterns. Thoughts of committing suicide or harming one's infant or children have also been reported as common occurrences in PPP, with as many as half of PPP cases exhibiting these features. In many cases where harmful thoughts exist, the person experiencing these thoughts does not consider their intended action to be harmful; rather, they believe that their actions are in the best interest of the child. In addition to the rapid onset of symptoms (less than two weeks) with the presence of a psychotic symptom, further diagnostic criteria defined by the DSM-V for "brief psychotic disorder with peripartum onset" includes that the symptomatic episode ends within one month and involves a return to the individual's previous functional ability, as well as confidence that the episode is not a different psychiatric illness (e.g., depressive or bipolar disorder with psychotic features) or the result of substance-induced psychosis. Risk Factors Childbirth is the leading cause of PPP, while other causes and risk factors remain largely under investigation. The largest reported risks for the occurrence of PPP include a prior history of having a postpartum psychotic episode, as well as having a known history of bipolar disorder (whether personally or within one's family history). A significant number of PPP cases, however, represent the first time an individual may experience any psychotic episode in their life; therefore, an individual may have no risk factors prior to developing PPP (though some may consider a first-time pregnancy to be the associated risk factor). A review of pregnancy-related complications demonstrated some association