Important point. I am surprised that the importance of an organic evaluation is being downplayed in postpartum presentations. 🚨 1/ The postpartum period is a major neuroendocrine, immune, metabolic and circadian transition. Abrupt changes in oestrogen, progesterone and neurosteroids, alongside sleep disruption, can alter CNS excitability and affective regulation. ( link to bipolarity ) 2/ Medical causes must be actively excluded, particularly in first-onset, atypical or rapidly evolving presentations. ( Kaleidoscopic) 3/ Thyroid disease deserves particular attention. Thyroid autoimmunity is reported in up to 20% of women with postpartum psychosis, and an immediately negative postpartum screen does not necessarily exclude later thyroid dysfunction because of postpartum immune rebound. 4/ Seizures, altered consciousness, dyskinesia, motor abnormalities or extrapyramidal features should raise suspicion for anti-NMDA receptor encephalitis and other autoimmune disorders prompting consideration of MRI, EEG, CSF and antibody testing. 5/ Rare metabolic disorders such as urea-cycle dysfunction may also first declare themselves postpartum; serum ammonia can be an important clue. “Postpartum psychosis / depression should describe the phenomenology and temporal context The phenomenology may be 1/ mixed state 2/ agitated depression 3/ psychotic presentation ( not always with hallucinations ) - often missed *even through the slide is for PPP - the distinction between PND and PPP is not clearcut as the most common presentation in PPP is depression / anxiety / irritability as key features. The strongest risk factor is a diagnosis of bipolar disorder.