Introduction and Initial Steps
Identify the Patient:
Ask for the patient’s name to ensure you are speaking to the right person.
Confirm it is a good time for the consultation.
Verify other identifiers (age, first line of address).
Backup Plan for Disconnection:
Ask if the line is reliable or if there is an alternative contact number in case of disconnection.
Main Consultation
Presenting Complaint:
Use existing information to save time (e.g., “I see you have problems with sleep. Can you tell me more about this?”).
Elaborate on the complaint by differentiating between difficulty falling asleep and staying asleep.
Explore History and Context:
Investigate if the sleep issue is a new problem or ongoing.
Discuss any triggering events, such as recent childbirth.
Duration of Symptoms:
Ask how long the patient has been feeling this way to differentiate between baby blues and postpartum depression.
Rapport Building
Acknowledgement and Empathy:
Congratulate the patient on the birth of their child.
Acknowledge any signs of distress or unusual behavior.
Detailed History Taking
Pregnancy and Postpartum Period:
Ask about the pregnancy and childbirth experience.
Inquire about the baby’s health and any abnormalities.
Self-Assessment:
Understand the patient’s mood and energy levels.
Ask about anhedonia (loss of interest in previously enjoyable activities).
Safety and Risk Assessment
Depression and Self-Harm:
Signpost before asking about self-harm and harm to the baby.
Ensure to address postpartum psychosis symptoms (hallucinations, intrusive thoughts).
Past Medical and Family History:
Collect information on past medical history, medications, and family support systems.
Assess daily activities and coping mechanisms.
Investigation and Diagnosis
Invite for Physical Examination:
Suggest a GP visit for further examination and tests (e.g., TFT, LFT, CBC, RFT).
Breaking the News:
Gradually inform the patient about the diagnosis (postpartum depression).
Tailor the explanation based on the patient's reaction.
Treatment Plan
Therapies and Medications:
Propose talking therapy, self-help strategies, yoga, and meditation.
If clinical depression is diagnosed, explain the need for medication (e.g., Sertraline).
Medication Details:
Discuss the important side effects of the medication.
Explain that the patient may not see immediate effects; the medication typically starts showing effects within 3-4 weeks.
Emphasize the importance of continuing the medication for at least six months to ensure effectiveness.
Additional Support:
Offer to connect the patient with social services or support groups (e.g., PANDAS, APNI).
Conclusion and Follow-Up
Safety Netting:
Provide a crisis plan with a 24-hour helpline number for emergencies.
Follow-Up:
Schedule a follow-up appointment in two weeks to review progress and make necessary adjustments.
Information and Resources:
Provide leaflets and pamphlets for additional information and support resources.
Essential Reminders
Always establish a clear understanding of the patient’s context and history.
Maintain empathy and build rapport throughout the consultation.
Ensure thorough safety assessments and provide detailed follow-up plans.
Utilize all available resources and support systems to aid the patient’s recovery and well-being.
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