Perinatal psychiatry in the general hospital

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Red flags

• Early postpartum rapid insomnia, confusion, mania, or psychosis — treat as postpartum psychosis emergency with mother and infant safety plan
• Ego-syntonic delusions or command hallucinations involving infant harm — psychosis pathway and safeguarding, not reassurance alone
• Active maternal suicidal plan or intent on maternity/medical ward — intensify observation and joint obstetric-psychiatric care
• Fluctuating confusion with hypertension, fever, or focal neurology — exclude eclampsia, infection, and organic causes before pure psychiatric labelling
• Abrupt stop of lithium or effective mood stabiliser at conception without a written relapse-prevention plan
• Valproate in pregnancy-capable patients without exceptional documented safeguards — major teratogen
• Processing irreversible obstetric refusals or discharge with infant while capacity is impaired by psychosis, delirium, or severe depression