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Major depressive disorder early SSRI follow-up — USMLE Step 3 MCQ

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HardPsychiatryMajor depressive disorder early SSRI follow-upUSMLE Step 3

Five days after an uncomplicated delivery, a 29-year-old woman has slept less than 2 hours total, says that the infant is divinely possessed, and reports a voice commanding her to purify the child. She alternates between agitation and staring, refuses to let family hold the infant, and has no prior psychiatric history. Vital signs and neurologic examination are normal. Which management is most appropriate?

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Correct answer: E — Separate mother and infant and admit her for inpatient psychiatric stabilization

The best answer is “Separate mother and infant and admit her for inpatient psychiatric stabilization”. Postpartum psychosis can begin abruptly with insomnia, mania, delusions, hallucinations, confusion, and rapidly fluctuating behavior. Command hallucinations involving the infant create immediate risk of suicide or infanticide. The mother must not be left alone with the infant and needs emergency psychiatric hospitalization, medical assessment for secondary causes, and rapid antipsychotic or mood-stabilizing treatment rather than routine outpatient depression care.

Reference: ACOG: Assessment and Treatment of Perinatal Mental Health Conditions: https://www.acog.org/programs/perinatal-mental-health/assessment-and-treatment-of-perinatal-mental-health-conditions