A 29-year-old primigravida delivers normally. On day 4 postpartum her family notices insomnia, restlessness, and refusal to eat. By day 7 she is hearing voices commanding her to harm the baby and believes the baby is possessed. She has no prior psychiatric history. What is the diagnosis?

• A Postpartum psychosis ✓
• B Postpartum depression with psychotic features
• C Postpartum blues
• D Brief psychotic disorder unrelated to childbirth

Explanation

Postpartum psychosis is a psychiatric emergency that characteristically begins within the first 1 to 2 weeks after delivery, often abruptly around day 3 to day 10, with hallucinations, delusions, confusion, and risk of infanticide or suicide. The postpartum blues peak around day 4 to 5 but never include psychotic features, which eliminates option C. Many cases represent an unmasking of bipolar illness, and management usually involves hospitalisation with antipsychotics and consideration of ECT.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.