Perinatal psychiatry in the general hospital — structured clinical viva

Open with dual-risk emergency framing. Day-4 rapid elevation, sleeplessness, and persecutory ideas about the infant are postpartum psychosis, not blues. Same-day senior review, medical exclusion, secure care, infant safety plan.^[1][8]

EPDS. Screening tool for depressive symptoms — does not diagnose or exclude psychosis; full MSE required.^[2]

Lithium history. Stopping lithium at conception removed prophylaxis in high-risk bipolar; counsel future pregnancies with Patorno absolute-risk framing and peri-delivery logistics.^[3][8]

Treatment. Bergink-style pathway: sleep, antipsychotics, lithium, consider ECT if life-threatening/refractory.^[4][7]

Lactation. Individualise; for depression needing SSRI, sertraline often preferred for lactation exposure data — here illness is psychotic/bipolar so prioritise maternal stabilisation and neonatology advice on feeding with chosen agents.^[5][4]

Disposition. MBU if available; else psychiatric unit with supervised infant contact.^[6]