A 26-year-old primiparous woman, 5 days postpartum, presents with acute-onset confusion, bizarre behaviour, auditory hallucinations (hearing her deceased grandmother commanding her), grandiosity, and severe insomnia. She had no prior psychiatric history. This is best classified as:

• A Postpartum depression
• B Postpartum psychosis ✓
• C Postpartum blues
• D Acute schizophreniform episode

Explanation

Postpartum psychosis is a psychiatric emergency presenting within the first 1–2 weeks postpartum (peak days 2–5) with rapid-onset confusion, disorientation, psychotic features (hallucinations, delusions), severe mood disturbance, and profound insomnia. It is distinct from postpartum blues (mild, day 3–5, self-limiting, no psychosis) and postpartum depression (onset within 4 weeks, not psychotic). Postpartum psychosis carries a 5% infanticide and 5% suicide risk and requires urgent inpatient admission, antipsychotics, and mood stabilisers. A prior history of bipolar disorder markedly increases risk (20–50%).

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.