A 27-year-old primipara presents on day 4 postpartum with confusion, sleep disturbance, auditory hallucinations, and lability. She rapidly shifts between elation and tearfulness. Which diagnosis requires IMMEDIATE inpatient psychiatric admission?
- A Postpartum blues
- B Postpartum psychosis ✓
- C Postpartum depression (mild)
- D PTSD following traumatic delivery
Explanation
Postpartum psychosis is a psychiatric emergency with onset typically within the first 2 weeks postpartum (peak: days 3–5). It presents with rapidly fluctuating confusion, hallucinations, delusions, and severe mood lability. It carries a significant risk of infanticide and suicide, mandating immediate inpatient psychiatric admission (mother-and-baby unit if available). Postpartum blues (peak day 3–5) are transient, self-limiting, and do not include psychosis or hallucinations. Postpartum depression has a more gradual onset and does not include psychotic features in the typical case.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.