A 26-year-old woman delivers a healthy infant. On day 5 postpartum she develops severe insomnia, agitation, mood lability, and command hallucinations telling her to drown the baby. She has no prior psychiatric history. What is the most likely diagnosis?

• A Postpartum blues
• B Postpartum depression
• C Adjustment disorder with mixed anxiety and depressed mood
• D Postpartum psychosis ✓

Explanation

Postpartum psychosis presents within the first 2 to 4 weeks after delivery with acute onset of psychotic features, mood lability, disorganisation, and command hallucinations. It is a psychiatric emergency and carries risk of infanticid. Postpartum blues is mild and self-limited within 2 weeks. Postpartum depression lacks psychotic features. Adjustment disorder does not present with command hallucinations.

Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.