A 28-year-old woman, 10 days postpartum, presents with acute onset insomnia, irritability, and confusion. She reports hearing voices telling her to drown her baby in the bath. She is agitated and has not slept for 3 nights. Which is the most appropriate immediate management?

• A Outpatient sertraline with weekly follow-up
• B Observe for spontaneous resolution over the next 2 weeks
• C Reassurance and sleep hygiene counselling
• D Hospitalization and initiation of a mood stabilizer with or without an antipsychotic ✓

Explanation

Postpartum psychosis is a psychiatric emergency with high risk of infanticide and suicide. The presence of command hallucinations to harm the infant mandates urgent hospitalization. Treatment involves mood stabilizers, often lithium, with or without antipsychotics. Outpatient management is unsafe in this setting.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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