Fit and exclusions
Start with the deciding signal, then test chronology, competing explanations, and the effect on diagnostic wording.
- Episode onset is clearly linked to pregnancy or the early post-birth period.
- The assessment distinguishes depressive, manic-spectrum, psychotic, anxiety, trauma, and adjustment presentations.
- Parent, infant, sleep, feeding, support, and safeguarding needs are considered together.
- The episode clearly pre-dated pregnancy without a meaningful peripartum onset or recurrence.
- Symptoms are better explained by transient adjustment alone, while still recognising that distress may require care.
- Screen urgently for psychosis and mania
- Assess parent and infant safety
- Review sleep loss, supports, medicines, and feeding context
- “This began during the pregnancy”
- “I have not felt like myself since the birth”
- “I am frightened by what my mind is doing”
Coordinate timely perinatal mental health care; new psychosis, mania, or severe deterioration requires urgent escalation.