Postpartum Psychosis Recurrence — MRCPsych Paper B MCQ

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HardPerinatal PsychiatryPostpartum Psychosis RecurrenceMRCPsych Paper B

A 25-year-old woman with bipolar I disorder is reviewed after recovering from postpartum psychosis that began 5 days after her first delivery. She is planning another pregnancy. Before considering the effect of individualised prophylactic treatment, what is the approximate risk that she will experience another episode of postpartum psychosis after a future delivery?

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Correct answer: C — 50%

The correct answer is C: approximately 50%. Previous postpartum psychosis is one of the strongest predictors of another postpartum psychotic episode. The Royal College of Psychiatrists estimates the risk after a future birth at about 1 in 2; a UK cohort found a recurrence rate of 57%. The 20% estimate applies approximately to a first pregnancy in someone with bipolar I disorder but no previous postpartum psychosis. A risk near 10% is reported for a second pregnancy in bipolar I disorder when the first pregnancy was not followed by postpartum psychosis. The population risk is approximately 0.1%, while 80% substantially overestimates the established recurrence risk. This high risk warrants specialist preconception counselling and an individualised perinatal management plan.

Reference: Royal College of Psychiatrists. Postpartum psychosis, sections ‘Who is most likely to get postpartum psychosis?’ and ‘How likely is it to happen again?’. Current webpage, accessed 19 August 2026. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/postpartum-psychosis