Anxiety and related disorders: postpartum obsessions of harm: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Anxiety and related disorders: postpartum obsessions of harm

Sample item

A mother of a six-week-old baby has frequent intrusive images of dropping the baby from the balcony. She is horrified, avoids bathing the baby, and checks on her repeatedly. She has no hallucinations, delusions or elevated mood, and insight is intact. What is the most appropriate approach?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Reassure her that these are obsessions, and treat as OCD with CBT or an SSRI while she stays with the baby

Intrusive, unwanted, ego-dystonic harm thoughts with distress and avoidance are obsessions, and mothers with them rarely act on them. Postpartum psychosis, in contrast, shows loss of insight, delusions or hallucinations and confusion, and carries real risk.

Option by option

  • A. Start lithium for postpartum bipolar illness

    There is no evidence of mania or bipolar disorder, so lithium is not indicated.

  • B. Admit to a mother and baby unit and start an antipsychotic

    Antipsychotic treatment and admission suit postpartum psychosis, which is absent here.

  • C. Reassure her that these are obsessions, and treat as OCD with CBT or an SSRI while she stays with the baby (correct)

    Correct. Distressing, resisted thoughts with intact insight are obsessions, not intent.

  • D. Inform child protection services and separate her from the baby

    Separation is not needed because the risk of harm is very low, and it would worsen her distress.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Reassure her that these are obsessions, and treat as OCD with CBT or an SSRI while she stays with the baby. Intrusive, unwanted, ego-dystonic harm thoughts with distress and avoidance are obsessions, and mothers with them rarely act on them.

Why is "Start lithium for postpartum bipolar illness" not the answer?

There is no evidence of mania or bipolar disorder, so lithium is not indicated.

Why is "Admit to a mother and baby unit and start an antipsychotic" not the answer?

Antipsychotic treatment and admission suit postpartum psychosis, which is absent here.

Why is "Inform child protection services and separate her from the baby" not the answer?

Separation is not needed because the risk of harm is very low, and it would worsen her distress.

What concept does this question test?

It tests Anxiety and related disorders: postpartum obsessions of harm in Psychiatry. Postpartum psychosis, in contrast, shows loss of insight, delusions or hallucinations and confusion, and carries real risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anxiety and related disorders: postpartum obsessions of harm?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.