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Postpartum Psychosis — MRCPsych Paper B MCQ

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ModerateMood DisordersPostpartum PsychosisMRCPsych Paper B

Three days after an uncomplicated delivery, a 29-year-old woman with no previous psychiatric history suddenly becomes agitated and confused. She believes that her baby has been replaced and tries to leave the maternity ward. Initial obstetric assessment identifies no acute medical complication. What is the most appropriate next action?

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Correct answer: D — Refer immediately to secondary mental health services for assessment within 4 hours, preferably involving a specialist perinatal mental health service

This sudden onset of agitation, confusion and a delusion within days of childbirth strongly suggests postpartum psychosis, a psychiatric emergency. NICE CG192 requires immediate referral to secondary mental health services for assessment within 4 hours, preferably by a specialist perinatal service. Treatment, risk management and the need for detention or admission are determined through that urgent assessment. A 24-hour or 2-week wait is unsafe because symptoms can deteriorate rapidly and may endanger the mother or baby. Medication may be required but should not delay specialist assessment. Most women requiring inpatient treatment should normally be admitted with their baby to a specialist mother and baby unit, but direct admission without an urgent mental health assessment is not the initial action specified by NICE.

Reference: National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192), recommendations 1.5.12 and 1.10.1. Published 2014; updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations