skip to main content

Postpartum Psychosis Prophylaxis Strategy — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePerinatal PsychiatryPostpartum Psychosis Prophylaxis StrategyMRCPsych Paper B

A 32-year-old woman is 36 weeks pregnant. Five days after her previous delivery, she developed postpartum psychosis requiring admission. She made a full recovery and has never experienced a mood or psychotic episode outside the postpartum period. She has remained well during this pregnancy without psychotropic medication. She has no contraindication to lithium and does not plan to breastfeed. Following specialist perinatal psychiatric assessment, which strategy is most appropriate to reduce her risk of recurrence while avoiding antenatal fetal exposure?

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

Reveal the answer and explanation

Correct answer: C — Lithium prophylaxis immediately after birth

The correct answer is C. Her previous illness was confined to the postpartum period, and she has remained well without medication during pregnancy. In this pattern, lithium prophylaxis should be initiated immediately after delivery, avoiding antenatal exposure while covering the period of greatest relapse risk. Lithium requires baseline renal and thyroid assessment, serum-level monitoring and careful management of hydration and interacting medicines. Sertraline does not prevent postpartum mania or psychosis. Valproate is not preferred for perinatal prophylaxis and is subject to stringent UK reproductive-safety restrictions. Waiting for symptoms to recur is unsafe because postpartum psychosis can deteriorate rapidly and carries substantial risks to mother and infant. Continuous prophylaxis during pregnancy would be more relevant to established bipolar disorder with non-postpartum episodes or antenatal relapse risk.

Reference: Bergink V et al. Prevention of postpartum psychosis and mania in women at high risk. American Journal of Psychiatry. 2012;169:609–615. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/lithium-in-pregnancy-and-breastfeeding