A 26-year-old primipara presents on day 4 postpartum with rapid onset confusion, disorganized speech, visual hallucinations, marked mood lability alternating between euphoria and terror, and severe insomnia. She has no prior psychiatric history. The MOST likely diagnosis is:
- A Postpartum psychosis ✓
- B Postpartum depression
- C Postpartum blues
- D Adjustment disorder with anxious mood
Correct answer: A. Postpartum psychosis
Explanation
Postpartum psychosis is a psychiatric emergency occurring within the first 2 weeks (peak: days 3-7) postpartum. It presents with rapid onset confusion, hallucinations, severe mood lability, and disorganized thinking — dramatically distinct from postpartum blues (mild, self-limiting tearfulness) and postpartum depression (gradual onset, anhedonia, weeks after delivery). It is associated with bipolar disorder and requires immediate hospitalization due to infanticide risk.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.