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]

1. Define hospital perinatal CL — maternity/medical ward liaison across pregnancy and postnatal year; dual mother-infant risk.[1][8]
2. Blues vs PPP — days 3–5 mild lability vs rapid psychosis/mania early puerperium.[1]
3. EPDS one-liner — depression screen, not full risk tool.[2]
4. Patorno one-liner — lithium cardiac malformation risk increased, absolute increase small; counsel and plan.[3]
5. PPP acute ladder — medical exclusion, secure setting, sleep, antipsychotic/lithium, ECT threshold.[4][7]
6. Sertraline lactation — often preferred SSRI when antidepressant indicated and breastfeeding desired.[5]
7. MBU — joint mother-infant psychiatric admission model when available.[6]
8. Capacity — decision-specific for discharge with infant and treatment; local law only.[1]