Telephone Consultation · Advanced · Psychiatry

Low Mood and Tearfulness in New Mother

Practise this PLAB 2 telephone consultation station on Postnatal Depression. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are a GP conducting a telephone consultation. You receive a call from Caroline Oldham, a 29-year-old woman who had her first baby three months ago. Her health visitor has suggested she contact you because she has been feeling tearful, anxious, and low in mood. The health visitor is concerned about possible postnatal depression. Please take a history and assess whether she needs further support or referral.

Background notes: PMH: Planned pregnancy, Straightforward labour and delivery (30 hours, epidural), Oliver 3 months old, breastfeeding, previous tongue tie treated

What this station tests

  • Edinburgh Postnatal Depression Scale framework for assessment
  • Distinguishing PND from baby blues (timeline) and puerperal psychosis (delusions, hallucinations)
  • Directly asking about thoughts of harming self and baby: essential safety assessment, does not cause harm
  • Sertraline as first-line SSRI in breastfeeding: minimal transfer to breast milk
  • Normalising PND: 1 in 10 mothers, illness not failure

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself and confirm patient identity. Explain purpose and check they can talk. Verify phone number for callback.
  • 1-3 min — Gather Information: Take focused history. Compensate for lack of visual cues with explicit questions about severity.
  • 3-5 min — Assessment: Summarise findings. Share working assessment. Identify any red flags requiring face-to-face review.
  • 5-7 min — Management Plan: Discuss management. Clear instructions. Ensure patient has means to follow plan (medications, transport to hospital).
  • 7-8 min — Safety Netting: Explicit safety netting (patient cannot see your expressions). When to call back, when to go to A&E. Confirm understanding.

Consultation approach

The opening

Postnatal depression is often hidden because mothers feel they 'should' be happy. Telephone assessment requires sensitive questioning and safety assessment for both mother and baby. Caroline is 29, 3 months postnatal, calling with low mood and tearfulness. She hesitated to call. Open with: 'Caroline, I am glad you called. It takes real strength to reach out. Tell me how you have been feeling.'

Core approach

Distinguish postnatal depression from baby blues (resolves within 2 weeks of birth) and puerperal psychosis (acute onset, delusions, hallucinations, confusion, a psychiatric emergency). At 3 months, baby blues is excluded by timeline. Screen for psychosis: any unusual thoughts about the baby? Hearing voices? Feeling the baby would be better off without her?

Use Edinburgh Postnatal Depression Scale (EPDS) framework. Persistent low mood, tearfulness, inability to enjoy the baby, feeling like a bad mother (overwhelming guilt), poor sleep (beyond normal newborn disruption), anxiety about the baby's health (checking breathing repeatedly), withdrawal from partner and friends.

Safety assessment: any thoughts of harming herself? Any thoughts of harming the baby? (Must be asked directly, not avoided.) These questions do not cause harm: they identify risk. Is the baby safe right now? Who else is at home?

Closing and safety netting

If moderate PND without psychosis or risk to baby: face-to-face appointment within 48 hours for full assessment. Health visitor informed (perinatal mental health support). Talking therapy: CBT or guided self-help. If moderate-severe: SSRI (sertraline is first-line as safe in breastfeeding). Reassure about breastfeeding: sertraline transfer to breast milk is minimal.

Normalise: 'Postnatal depression affects 1 in 10 mothers. You are not a bad mother. This is an illness, not a failure.' If any psychosis features or risk to baby: emergency psychiatric assessment today. Safety net: 'If you have any frightening thoughts about yourself or Oliver, or if you feel unable to cope, call us back immediately or go to A&E.' PANDAS Foundation for support. Follow-up: face-to-face within 48 hours.

How examiners mark this station

Examiners will assess all three domains, with particular attention to how you compensate for the lack of visual cues. Domain 1 (Data Gathering) focuses on your ability to take a thorough history remotely. Domain 2 (Clinical Management) assesses the clarity of your management plan and quality of safety netting. Domain 3 (Interpersonal Skills) assesses your telephone communication skills.

Domain 1 (Primary focus)

Scores well: EPDS framework applied. Baby blues and psychosis distinguished. Safety assessed (self and baby). Breastfeeding status checked. Support network assessed.

Costs marks: Not assessing safety. Not distinguishing from psychosis. Not checking support.

Domain 2 (Primary focus)

Scores well: Face-to-face within 48 hours. Health visitor informed. CBT offered. Sertraline if moderate-severe. Breastfeeding safety confirmed. PANDAS Foundation.

Costs marks: No follow-up plan. Advising stopping breastfeeding. No health visitor. No support resources.

Domain 3 (Primary focus)

Scores well: Normalising PND (1 in 10). Addressing 'bad mother' guilt. Validating her call. Warm, supportive telephone manner.

Costs marks: Reinforcing guilt. Being clinical on the phone. Not normalising.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Ask explicitly about things you would normally observe: 'Can you describe the rash for me?', 'How severe is the pain on a scale of 1-10?', 'Are you able to walk around?'

Did not provide adequate safety netting

Fix: Be very specific: 'If you develop X, Y, or Z, go directly to A&E or call 999.' Confirm the patient has understood and can access care if needed.

Common mistakes in this station

  1. Not asking about thoughts of harming the baby: this must be asked directly, avoidance risks missing a safety issue
  2. Confusing PND with puerperal psychosis: psychosis is acute onset with delusions and is a psychiatric emergency
  3. Advising stopping breastfeeding to take medication: sertraline is safe in breastfeeding

Resitting PLAB 2?

If telephone consultation stations have been difficult, remember that you must compensate for the lack of visual cues with explicit verbal checking. Describe what you would normally observe, ask about severity in concrete terms, and provide very clear safety netting since the patient cannot see your facial expressions.

Example opening

Hello, am I speaking with [patient name]? Could I confirm your date of birth please? My name is Dr [Name], I'm calling from [surgery/hospital]. Is this a good time to talk? Are you somewhere private?

Frequently asked questions

How should I run this postnatal depression telephone consultation in PLAB 2?

Postnatal depression is often hidden because mothers feel they 'should' be happy. Telephone assessment requires sensitive questioning and safety assessment for both mother and baby. Caroline is 29, 3 months postnatal, calling with low mood and tearfulness.

Where are marks won and lost in this postnatal depression station?

Examiners reward: EPDS framework applied. Baby blues and psychosis distinguished. Safety assessed (self and baby). Breastfeeding status checked. Support network assessed. Candidates are penalised for: Not assessing safety. Not distinguishing from psychosis. Not checking support.

Where do candidates most often go wrong in this station?

Not asking about thoughts of harming the baby: this must be asked directly, avoidance risks missing a safety issue.

Can I do well in this station without real-world experience of postnatal depression?

This station rewards process over personal experience. The skill being assessed: Distinguishing PND from baby blues (timeline) and puerperal psychosis (delusions, hallucinations). Work through the consultation approach above, then rehearse it aloud under the 8-minute time pressure so the structure holds up in the exam.

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