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Postpartum psychosis — MRCEM SBA MCQ

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EasyMental health and behavioural emergenciesPostpartum psychosisMRCEM SBA

A 31-year-old woman attends the emergency department with her partner six days after an uncomplicated delivery. Over the past 36 hours she has slept very little without feeling tired and has become increasingly animated. She insists that her baby has been replaced by an impostor and must not be fed. She is alert and orientated, afebrile and normotensive, with no headache, substance use or focal neurological findings. Her partner is caring for the baby, and she agrees to remain in the department. What is the most appropriate assessment and disposition plan?

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Correct answer: D — Arrange specialist mental health assessment within 4 hours; maintain safety in the department pending a care plan.

The abrupt onset of a fixed delusion and markedly reduced need for sleep six days after childbirth suggests postpartum psychosis, not transient postnatal mood changes. Her belief that the baby must not be fed makes the infant’s immediate safety relevant even though she is calm and agrees to stay. NICE recommends referral for immediate assessment by a secondary mental health service, preferably a specialist perinatal service, within 4 hours of referral. She should remain in a safe setting while assessment and a care plan are arranged, with her partner continuing to care for the baby. If inpatient psychiatric care is needed, a specialist mother and baby unit is normally the preferred setting. ([nice.org.uk](https://www.nice.org.uk/guidance/cg192/chapter/Recommendations)) A mistakes psychotic symptoms for a problem suitable for routine follow-up. B recognises the need for specialist input but delays assessment and sends her home despite the infant-related delusion. C provides observation, but next-day psychiatric review misses the recommended assessment timeframe; physical or obstetric concerns should be assessed in parallel if they arise. E identifies a potentially appropriate inpatient setting but makes transfer the first decision, rather than arranging immediate specialist assessment and an individual safety and admission plan. ([nice.org.uk](https://www.nice.org.uk/guidance/cg192/chapter/Recommendations))

Reference: NICE CG192, Antenatal and postnatal mental health: recommendations 1.5.12 and 1.10.1 (Published 17 December 2014; last updated 11 February 2020) — https://www.nice.org.uk/guidance/cg192/chapter/Recommendations NHS, Postpartum psychosis (Last reviewed 18 October 2023) — https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/