Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining postpartum psychosis and infant safety on the maternity ward — CASC communication station
MRCPsych/FRANZCP-style station: explain PPP as emergency, dual mother-infant risk, treatment outline, lithium counselling principles, and collaborative plan with maternity.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar. The partner attends; midwifery staff may be available for a joint plan.[1][3]
Candidate instructions. Explain that this presentation is postpartum psychosis, a treatable psychiatric emergency, not ordinary blues. Explain why same-day hospital care and infant safety planning are needed. Outline treatment (sleep, medicines, possible specialist mother-baby unit) without jargon overload. Address lithium fear with balanced risk language. Check understanding and agree next steps with maternity.[1][2][3][4]
Candidate scenario
Partner: “She just needs sleep at home. You’re treating her like she is crazy and a danger to our baby. Lithium is poison in pregnancy — that is why she stopped it. Score her on that depression form and let us go.” Mother is restless, irritable, and insists the baby is not hers.[1][2]
Marking domains
- Empathy without colluding with unsafe discharge
- Clear plain-language explanation of PPP vs blues
- Dual risk: mother and infant safety without stigma
- Treatment outline: medical checks, sleep, medicines, possible MBU
- Balanced lithium counselling (risk-benefit, not slogans)
- Shared plan with maternity/midwifery and check-back
- Avoid over-reassurance that EPDS alone decides discharge [1][2][3][4][5]
Reveal assessor key
Open. Introduce role; acknowledge fear and love for partner and baby. “You want her home and safe — so do we. What is happening now is more than ordinary baby blues.” [1]
PPP explanation. “In the first days after birth some people develop a rapid severe illness called postpartum psychosis — poor sleep without tiredness, racing thoughts, and false beliefs, sometimes about the baby. It is a medical-psychiatric emergency and usually responds to treatment, but she needs secure care now.” [1][2]
Safety. “We make a plan that keeps both mother and baby safe. That may mean supervised contact and not going home alone tonight. This is not a moral judgement — it is how we treat this illness.” [1][3]
Treatment. “We check for medical causes, help her sleep, and use medicines that treat mania and psychosis. If needed we consider a mother-baby unit so she can be treated with the baby nearby.” [3][5]
Lithium. “Lithium decisions in pregnancy are individual. Research shows a small increase in absolute risk of heart malformations that still needs careful counselling — stopping without a plan can also be risky after previous postpartum mania. We will discuss options with obstetrics for now and for the future.” [4][2]
Close. Summarise plan: stay in hospital/secure setting, safety for infant, medicines, daily review, possible MBU transfer, partner updates. Invite questions and check understanding.[3][5]
References
- [1]Bergink V, Rasgon N, Wisner KL Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood Am J Psychiatry, 2016.PMID 27609245
- [2]Jones I, Chandra PS, Dazzan P, Howard LM Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period Lancet, 2014.PMID 25455249
- [3]Bergink V, Burgerhout KM, Koorengevel KM, Kamperman AM, Hoogendijk WJ, Lambregtse-van den Berg MP, et al. Treatment of psychosis and mania in the postpartum period Am J Psychiatry, 2015.PMID 25640930
- [4]Patorno E, Huybrechts KF, Hernandez-Diaz S Lithium Use in Pregnancy and the Risk of Cardiac Malformations N Engl J Med, 2017.PMID 28854098
- [5]Galbally M, Sved-Williams A, Kristianopulos D, Mercuri K, Brown P, Buist A Comparison of public mother-baby psychiatric units in Australia: similarities, strengths and recommendations Australas Psychiatry, 2019.PMID 30407072