GP CCE Cases · mental-health
Six-week postnatal check with raised EPDS — CCE clinical encounter
CCE-style clinical encounter: a 31-year-old first-time mother at her six-week check scores 16 on the EPDS. The candidate must confirm PND, screen for puerperal psychosis and risk of harm, offer CBT as first-line, discuss sertraline if needed, and involve the partner.
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RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 31-year-old teacher attends her baby's six-week immunisation appointment. The practice nurse has completed the EPDS: score is 16 (cut-off 13). She says she is 'fine, just tired'. On observation she avoids eye contact with the baby, speaks in flat tone about the birth, and mentions she 'can't seem to enjoy anything anymore'. Her partner works long hours. No previous psychiatric history.
Objectives
- Confirm PND through structured assessment beyond the EPDS screening result. [1]
- Screen for puerperal psychosis and risk of harm to self or baby. [2]
- Offer CBT as first-line psychological therapy with honest efficacy framing. [5]
- Discuss sertraline in breastfeeding if pharmacotherapy is needed. [3]
- Involve partner and arrange structured follow-up.
References4ShowHide
- [1]Cox JL, Holden JM, Sagovsky R Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry, 1987.PMID 3651732
- [2]Pinheiro E, Bogen DL, Hoxha D, Ciolino JD, Wisner KL Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health, 2015.PMID 25589155
- [3]Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Am J Psychiatry, 2016.PMID 26514657
- [5]Leng LL, Xiao W, He X, Wang T, Ning K Efficacy of psychological treatments for perinatal depression and anxiety: systematic review and network meta-analysis. Br J Psychiatry, 2026.PMID 42343881