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Home / Station 12: Postpartum low mood and unusual beliefs

NAC OSCE preparation

Station 12: Postpartum low mood and unusual beliefs

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Postpartum low mood and unusual beliefs

11 minutes

Discipline: Obstetrics & Gynecology
Station type: Mental-health interview + safety plan
Setting: Postpartum clinic

Your task

Interview a patient 12 days postpartum. Assess mental state and safety, then explain the immediate plan.

Information available at entry

Vital signs stableNo fever or focal neurologic findings

Coach prompt: Recognize postpartum psychosis and protect parent and infant.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 12 of 30

Standardized-patient profile

NameMs. Emily Brown

Age33

Pronounsshe/her

RolePatient; partner available

Demeanour: Guarded, distracted and intermittently whispering.

Opening statement: “My baby is special. The television is sending me messages about how to keep him safe.”

History and standardized-patient responses

Mood/psychosis

Candidate explores	Standardized-patient response
Sleep	Less than two hours nightly for four nights.
Mood/energy	Unusually energized and says she does not need sleep.
Beliefs	Television messages warn staff may steal baby.
Perception	Voice says to protect him at all costs.
Thought	Racing and tangential.

Safety

Candidate explores	Standardized-patient response
Self-harm	Says death would be acceptable if it saves baby.
Infant risk	Considered secretly leaving with baby; missed feeds.
Weapons/substances	No weapon or substance use.

Background

Candidate explores	Standardized-patient response
Psychiatric	Previous mania; stopped mood stabilizer before pregnancy.
Family	Mother had postpartum hospitalization.
Medical	No fever, seizure, headache or thyroid symptoms.
Support	Partner has taken over infant care.

Physical findings

Pressured speech, elevated/irritable mood, paranoid/referential delusions, auditory hallucinations and impaired insight/judgment.

Examiner prompts

Diagnosis?

Postpartum psychosis, likely mania with psychotic features—a psychiatric emergency.

Immediate plan?

Do not leave parent alone with infant, emergency psychiatric assessment/likely admission, partner-supported infant safety, capacity/legal assessment and medical evaluation.

Medical causes?

Thyroid disease, infection, medication/substance effects and neurologic or delirium causes.

Differential diagnosis

Postpartum psychosis/manic episode
Severe depression with psychosis
Substance/medication psychosis
Delirium
Postpartum thyroid disease

Investigations

Urgent psychiatric and medical assessment
CBC, electrolytes, renal/liver function, TSH and targeted toxicology
Neurologic/infectious workup if indicated

Management

Immediate supervision and emergency transfer
Likely inpatient perinatal psychiatric treatment
Psychiatric medication selected with breastfeeding and prior response considered
Safe infant-care plan and family support
Relapse-prevention planning

Communication behaviours

Validate distress without agreeing with delusions
Speak calmly and avoid confrontation
Explain that severe sleep loss and unusual messages require urgent treatment

Critical safety actions

Never leave parent and infant alone when harm risk is possible
Postpartum psychosis is an emergency even without direct suicidal intent
Use collateral and legal mechanisms when necessary

Model closing summary

This patient has postpartum psychosis with mania, delusions, command hallucinations, impaired infant care and possible risk to herself and her baby. I would ensure she is not left alone with the infant, obtain collateral information, arrange immediate psychiatric assessment and likely hospitalization, assess capacity and legal care needs, investigate medical causes and maintain a safe partner-led infant-care plan.

Common pitfalls

Calling it baby blues
Missing mania by asking only depression questions
Accepting denial without exploring commands
Routine outpatient follow-up

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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