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Postpartum Psychosis Prophylaxis — MRCPsych Paper B MCQ

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ModeratePerinatal PsychiatryPostpartum Psychosis ProphylaxisMRCPsych Paper B

A woman experienced postpartum psychosis after her first delivery. She has had no mood or psychotic episodes outside the postpartum period and is currently well and medication-free. During preconception counselling, she and the specialist perinatal mental health team agree that pharmacological prophylaxis will be considered following her next delivery. According to NICE CG192, when should the need to start psychotropic medication be reviewed?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — As soon as she is medically stable after childbirth

Explanation lettering: D = shown as A · A = shown as C · C = shown as D

B is correct. NICE CG192 classifies postpartum psychosis as severe mental illness and recommends reviewing the need to start, restart or adjust psychotropic medication after childbirth as soon as the woman is medically stable. This permits prompt implementation of an individualised prophylaxis plan during the period of greatest clinical concern. Waiting for prodromal symptoms (A) converts prevention into treatment of a possible recurrence. NICE does not recommend routine initiation at confirmation of pregnancy (C) or at 36 weeks (D) solely on the basis of previous postpartum psychosis; antenatal treatment depends on the individual risk–benefit assessment and any underlying disorder. Waiting until the 6-week review (E) would delay assessment beyond the early postnatal period in which postpartum psychosis commonly presents.

Reference: National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192), recommendation 1.9.1, 2014; last updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations