A 27-year-old primipara develops sudden-onset visual hallucinations, grandiosity, and rapid mood swings on day 4 postpartum. She has a personal history of bipolar disorder. What is the MOST important immediate management concern?
- A Start sertraline for postpartum depression
- B Hospitalise urgently due to risk of infanticide and self-harm ✓
- C Start melatonin for sleep disturbance
- D Schedule outpatient CBT within 2 weeks
Explanation
Postpartum psychosis is a psychiatric emergency with onset typically within days 2–14 postpartum. It is characterised by rapid onset of psychosis, severe mood disturbance (manic or mixed), confusion, and disorganised behaviour. It is strongly associated with bipolar disorder. The most critical concern is risk of infanticide (the mother may have delusional ideas involving the infant) and suicide. Immediate psychiatric hospitalisation, preferably in a mother-and-baby unit, is mandatory. Mood stabilisers (lithium preferred, or valproate) and antipsychotics are used; SSRIs alone are inadequate.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.