A 27-year-old primigravida delivers at term. On day 4 postpartum she develops florid delusions that her baby is possessed, disorganized behaviour, and insomnia. She has no prior psychiatric history. Her sister has bipolar disorder. Which statement about her condition is correct?

• A Recurrence risk with future pregnancies is negligible once the episode remits
• B It is almost always caused by postpartum thyroiditis and resolves with levothyroxine replacement
• C It carries a substantial risk of subsequent bipolar disorder, so longitudinal mood monitoring is essential ✓
• D It is best managed with reassurance and sleep hygiene alone, as it never requires hospitalization

Explanation

Postpartum psychosis peaks in the first 1 to 2 weeks after delivery and is a psychiatric emergency requiring hospitalization. Despite presenting as psychosis, a large proportion of affected women subsequently develop bipolar disorder, especially with a family history as here, so long-term mood surveillance is mandatory. Thyroid dysfunction may coexist but does not explain florid psychosis. Recurrence risk in future pregnancies is high, often above 50 percent, making option A false.

Reference: Shorter Oxford Textbook of Psychiatry, 7th ed.

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