A 27-year-old woman develops confusion, disorganized behaviour, and command hallucinations urging her to harm her baby, beginning four days after an uneventful delivery. She had one previous similar episode after her last pregnancy. What is the most important immediate concern regarding this condition?
- A High risk of subsequent bipolar disorder and of harm to the infant, usually requiring hospitalisation ✓
- B Benign self-limiting course identical to postpartum blues, requiring only reassurance
- C It is almost always caused by thyroid dysfunction and resolves with levothyroxine
- D It carries a high recurrence risk only if the mother has schizophrenia
Correct answer: A. High risk of subsequent bipolar disorder and of harm to the infant, usually requiring hospitalisation
Explanation
Postpartum psychosis is a psychiatric emergency with onset within days to two weeks of delivery, featuring hallucinations, delusions, and disorganization, and it carries a substantial risk of infanticide and suicide, mandating hospitalisation. Most cases represent an initial episode of bipolar disorder, and a large majority of affected women later develop bipolar illness, which explains her prior postpartum episode. Postpartum blues are mild, transient, and lack psychotic features, and thyroid dysfunction does not account for frank psychosis.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.