Explain postnatal depression treatment and infant-safety thoughts — CASC communication station

MRCPsych/FRANZCP-style communication station: explain postnatal depression and perinatal OCD-spectrum intrusions, distinguish from psychosis, discuss sertraline and breastfeeding principles, safety-netting and when services escalate — without false reassurance or stigma.

Prompt

A 31-year-old woman 5 weeks postpartum is distressed by unwanted images of harming her baby and has been offered sertraline for postnatal depression. She fears she is a 'monster', that medication will harm breastfeeding, and that social services will remove her child if she discloses the images.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the perinatal clinic. [3]

Candidate instructions. Build rapport, explore her fears, explain the likely formulation (postnatal depression with ego-dystonic intrusive thoughts), contrast with psychosis in plain language, discuss sertraline 50 mg daily and breastfeeding monitoring principles, outline psychological treatment and safety-netting, and address child-protection fears honestly without promising absolute secrecy if acute risk emerges. Check understanding. The examiner plays the patient. [1][4]

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References4Show ledger

[1]Speisman BB, Storch EA, Abramowitz JS Postpartum obsessive-compulsive disorder J Obstet Gynecol Neonatal Nurs, 2011.PMID 22092284
[2]Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants Am J Psychiatry, 2004.PMID 15169695
[3]Howard LM, Molyneaux E, Dennis CL, et al. Non-psychotic mental disorders in the perinatal period Lancet, 2014.PMID 25455248
[4]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391