Postpartum Psychosis — MRCPsych Paper B MCQ

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EasyPerinatal PsychiatryPostpartum PsychosisMRCPsych Paper B

A 35-year-old woman is admitted to a mother and baby unit 10 days after giving birth. Over the preceding 48 hours, she has developed severe low mood and agitation. She believes that her baby is evil and hears voices commanding her to harm the baby. She had no psychiatric symptoms during pregnancy and has no previous psychiatric history. Which perinatal diagnosis is most likely?

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Correct answer: C — Postpartum psychosis

The correct answer is C, postpartum psychosis. The decisive features are the rapid onset within 2 weeks of childbirth and clear psychotic symptoms: a delusion concerning the baby and command auditory hallucinations. Postpartum psychosis commonly has prominent affective symptoms, including severe depression, so a low mood does not make uncomplicated postnatal depression the better diagnosis. Postnatal depression may be severe, but the early postpartum psychotic presentation is classically described as postpartum psychosis and requires emergency assessment. Baby blues cause transient tearfulness and emotional lability without psychosis. Adjustment disorder does not adequately explain hallucinations or fixed delusions. Tokophobia is a severe fear of pregnancy or childbirth, rather than a postpartum psychotic syndrome.

Reference: NICE, Antenatal and postnatal mental health: clinical management and service guidance (CG192), Recommendations 1.5.11–1.5.12 and definition of postpartum psychosis, updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations