Perinatal mental health — KFP-style written assessment

KFP 1 (10 marks)

A 28-year-old first-time mother is seen at her six-week postnatal check. She reports feeling tearful and overwhelmed since delivery but says she is 'coping'. EPDS score is 16. She denies thoughts of self-harm or harm to the baby. ^[1]

1. Interpret her presentation and EPDS result. (4) ^[1]
2. What is the most likely diagnosis? Justify against baby blues and puerperal psychosis. (4) ^[2]
3. Outline your management plan. (2) ^[5]

Model answers

1. EPDS score of 16 is above the cut-off of 13 suggesting probable depression. At six weeks postpartum with persistent symptoms beyond the baby blues window, this requires clinical assessment to confirm PND. She denies psychotic features or thoughts of harm — reassuring. ^{[1] [2]}
2. Most likely postnatal depression: persistent low mood beyond two weeks (she is at six weeks) distinguishes it from self-limiting baby blues (day 3–5 peak, resolving within two weeks). No delusions or hallucinations about the baby distinguish it from puerperal psychosis. The EPDS screens — clinical assessment confirms. ^{[1] [2]}
3. Offer CBT as first-line psychological therapy (network meta-analysis SMD −0.55 vs TAU across 78 RCTs). Consider SSRI if moderate-to-severe or if CBT unavailable; sertraline preferred in breastfeeding (87.4% infant levels below limit of detection). Book follow-up within two weeks; screen partner mental health. ^{[5] [3]}