Postpartum Psychosis — MRCPsych Paper B MCQ

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EasyPerinatal PsychiatryPostpartum PsychosisMRCPsych Paper B

A 30-year-old woman is assessed 5 days after giving birth. Over the preceding 24 hours, she has become markedly confused and suspicious, stating that hospital staff intend to harm her baby. She also reports hearing voices discussing the baby. She has no previous psychiatric history. Her physical examination and observations are unremarkable. What is the most likely diagnosis?

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Correct answer: C — Postpartum psychosis

The correct answer is C, postpartum psychosis. Its characteristic features are sudden onset in the immediate postnatal period, commonly within the first 2 weeks, with delusions, hallucinations, confusion and often prominent or rapidly changing mood symptoms. A previous psychiatric history is not required. Postnatal depression typically causes persistent low mood, anhedonia and impaired functioning rather than an acute confused psychotic state. Baby blues are mild, transient mood lability without psychosis. Tokophobia is a severe fear of pregnancy or childbirth, while post-traumatic stress disorder requires a traumatic event followed by symptoms such as re-experiencing, avoidance and hyperarousal. Postpartum psychosis is a psychiatric emergency requiring immediate specialist assessment; NICE specifies assessment within 4 hours of referral.

Reference: National Institute for Health and Care Excellence. 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; reviewed 2025. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations