Perinatal mood and anxiety disorders

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Red flags

• Postpartum psychosis or new mania/mixed state after birth — psychiatric emergency; same-day senior review, secure setting, infant safety plan
• Active suicidal intent or plan in the perinatal period — intensify care; maternal suicide is a leading cause of late maternal death in high-resource settings
• Ego-syntonic delusions or command hallucinations involving harm to the infant — treat as psychosis pathway with safeguarding, not as 'normal anxiety'
• Inability to care for the infant safely, severe neglect risk, or filicide ideation with intent — escalate setting and multi-agency safeguarding
• Abrupt cessation of effective mood stabiliser or antidepressant at conception without risk-benefit plan — relapse risk may exceed medication risk
• Valproate exposure in pregnancy-capable patients without exceptional safeguards — major teratogen; avoid and counsel