Dr. Georgette Quie, DNP (@drgeorgette)

Neuropsychological testing is not routinely required for every child or adult who reports ADHD symptoms. ADHD is diagnosed through a comprehensive clinical assessment. Testing can help answer specific questions, but it is not a stand-alone diagnostic test or a routine prerequisite for treatment. For children and adolescents, the assessment should determine whether diagnostic criteria are met, whether symptoms and impairment occur in more than one setting, and whether other conditions may explain or contribute to the symptoms. Parent and school information can help build that picture. Neuropsychological testing generally does not improve diagnostic accuracy, though it may clarify learning strengths and needs. For adults, assessment should cover current symptoms and impairment, developmental history, evidence of symptoms during childhood, and possible co-occurring or alternative conditions. Collateral information can be helpful when available. Rating scales and tests may inform the evaluation, but they do not replace a full clinical assessment. Testing may be useful when there is a specific question, such as suspected learning difficulties, cognitive changes, neurological concerns, or a complex differential diagnosis. Results should be interpreted alongside the person’s history and real-world functioning. Five clinical pearls for psychiatric providers Start with the clinical question. Mentor comment: “Before referring for testing, clarify what decision the results could inform. Testing is most useful when it addresses a specific diagnostic, educational, or treatment-planning need.” For children, gather information across settings. Mentor comment: “Parent and school observations can help clarify symptoms and impairment. Explore differences between reports in context rather than relying on one rating or informant alone.” For adults, assess the developmental timeline. Mentor comment: “Ask for concrete examples of childhood symptoms and consider records or collateral history when available. Missing school records alone do not confirm or rule out ADHD.” Assess impairment and other possible explanations. Mentor comment: “Consider sleep problems, mood and anxiety disorders, trauma, substance use, learning difficulties, medical factors, and conditions that may mimic or coexist with ADHD.” Do not make testing a routine gate to care. Mentor comment: “When the clinical assessment supports ADHD, treatment planning should be guided by the patient’s needs, safety, and applicable clinical standards, not by a test score alone.” Educational content for psychiatric providers. Follow current diagnostic standards, scope of practice, and local requirements. Guidelines consulted: American Academy of Pediatrics, Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents; NICE Guideline NG87, Attention deficit hyperactivity disorder: diagnosis and management; Australian ADHD Professionals Association, Australian Evidence-Based Clinical Practice Guideline for ADHD. #adhdinwomen #adhd #pmhnp #psychiatrist #nursepractitioner

Owning a private practice is about more than choosing a name and seeing clients. True independence means having control over how your practice is set up, how you’re credentialed, and how you work with insurance companies. Third-party platforms can help simplify the process, but relying on one for credentialing and payer access may limit your control. When your credentials and insurance relationships are tied to a platform, your options may depend on its terms. Build a practice that belongs to you. Fast Track Credentialing helps providers credential directly with insurance companies so they can build and grow their practices on their own terms. Learn more at www.fasttrackcredentialing.com. Your practice. Your credentials. Your independence. #pmhnp #lcsw #therapist #psychiatrist #insurancecredentialing

A history of substance misuse does not automatically mean “no stimulants” for a patient with ADHD. The clinical question isn’t simply, “Have they ever misused a substance?” It’s: What are the benefits and risks for this patient now, and what treatment plan can address both ADHD and substance-related concerns? Five clinical pearls for psychiatric providers Confirm the ADHD diagnosis. Assess for symptoms beginning in childhood, impairment across settings, and other explanations for attention or impulse-control problems, including substance effects, withdrawal, sleep disorders, and mood symptoms. Use the longitudinal history and collateral information when available. Mentor note: A screening score is not a diagnosis. Build the formulation from the developmental timeline, functional impairment, and differential. Characterize the substance-use history. Clarify the substance, pattern, severity, recency, treatment history, recovery supports, and any history of prescription-stimulant misuse or diversion. A remote history is different from current instability, but neither should be reduced to a label. Mentor note: Ask directly and without judgment. The details guide the plan, not the diagnosis alone. Individualize medication selection. If a stimulant is appropriate, consider an extended-release formulation when it fits the clinical picture. If the risks outweigh the benefits, consider nonstimulant medication and behavioral interventions. No formulation removes misuse or diversion risk. Mentor note: “Long-acting” is a risk-reduction consideration, not a guarantee of safety. Set a clear monitoring plan. Agree on treatment goals and follow-up. Monitor symptom response, functioning, adverse effects, substance use, and possible misuse or diversion. Use prescription-monitoring data and other safeguards when clinically indicated and consistent with applicable requirements. Mentor note: Monitoring should be purposeful and proportionate, not a substitute for a therapeutic relationship. Treat co-occurring conditions together. When ADHD and substance use disorder coexist, address both in the care plan. Coordinate with addiction-treatment clinicians and other prescribers when appropriate and with the patient’s consent. Reassess if substance use, safety, or treatment response changes. Mentor note: Avoid making “complete abstinence first” a blanket rule. The timing and approach should reflect the patient’s presentation, diagnostic clarity, and safety needs. Key takeaway. Neither “stimulants for everyone” nor “no stimulants after any substance-use history” is an individualized treatment plan. Assess, discuss options, document the rationale, and keep reassessing. #adhd #adhdinwomen #pmhnp #pmhnpstudent #nursepractitioner

Comments like this can sting. It’s a painful stereotype, but it points to a real responsibility: passing boards is only one step. Strong psychiatric care also takes sound clinical reasoning, thoughtful decision-making, and the confidence to keep learning. Whatever program we attend, our education is only the beginning. We each have a responsibility to keep learning and build mastery in the skills we use every day. We’re caring for real people, whose lives and well-being may be shaped by our assessments and decisions. We can’t rely on guesswork; we must keep studying, applying evidence, and reflecting on our practice. The Academy of Psychiatry’s mentorship programs support PMHNP students, new graduates, experienced PMHNPs, and other psychiatric providers as they strengthen their assessment, differential diagnosis, treatment planning, and clinical decision-making through evidence-informed education and real-world case studies. We’ve supported thousands of future and practicing PMHNPs, one clinician at a time. We’re proud of that work, but the goal is bigger than any program: helping providers deliver thoughtful care to the people who trust them with their lives. Explore our programs: www.psychiatrymentorshipacademy.com #pmhnp #pmhnpstudent #pmhnpmentor #psychnp #nursepractitioner

Just finished your PMHNP program and feeling unprepared for your first patient? Or are you an experienced PMHNP ready to sharpen your clinical skills? Learning doesn’t stop after graduation or after passing your PMHNP certification exam. The Academy of Psychiatry: Clinical Excellence & Entrepreneurial Mentorship supports psychiatric providers at every career stage. Our offerings include one-to-one mentorship, Clinical Psychiatry Boot Camp, case studies, and other educational opportunities. Explore topics such as psychiatric assessment, differential diagnosis, psychopharmacology, treatment planning, risk and safety assessment, clinical documentation, and decision-making across the lifespan, including perinatal, child and adolescent, adult, geriatric, and addiction psychiatry. Whether you’re preparing to see your first patient or refining years of practice, find opportunities to keep learning and strengthen your clinical confidence. Explore our programs at www.psychiatrymentorshipacademy.com #pmhnp #pmhnpstudent #nursepractitioner #nursepractitionerstudent #pmhnpmentor

Yesterday, nearly 1,000 psychiatric providers joined the Academy of Psychiatry: Clinical Excellence & Entrepreneurial Mentorship for an incredible session on perinatal psychiatry and complex clinical case studies. Thank you to everyone who spent part of their Sunday learning with us. Your questions, perspectives, and shared experiences made the session meaningful. The live event may be over, but the learning continues. CONTINUE LEARNING AT YOUR OWN PACE Get the 4-hour Zoom presentation recording and a downloadable 970-page Psychiatry Clinical Reasoning Casebook with 49 comprehensive cases across the lifespan. For a limited time, save $100: Regular price: $399 Sale price: $299 Code: CASESTUDY100 Offer ends October 10, 2026 Enroll: www.psychiatrymentorshipacademy.com/psychiatry-case-studies WHAT’S INCLUDED - 49 psychiatric case studies spanning perinatal, child and adolescent, adult, geriatric, and addiction psychiatry - DSM-5-TR diagnoses and codes, differential diagnoses, and clinical rationales - Medication options, doses, monitoring, and psychopharmacology considerations - Suggested laboratory and diagnostic workups - Risk, safety, and level-of-care considerations - Follow-up recommendations and individualized treatment planning - Documentation guidance, SOAP note examples, and practical clinical pearls - Downloadable materials for continued study and reference MORE THAN MAKING A DIAGNOSIS The goal is to strengthen how you reason through the patient in front of you: developing a differential, considering medical causes and workups, selecting treatment, assessing safety, determining level of care, planning follow-up, and documenting your clinical reasoning. Designed for PMHNP students, new graduates, practicing PMHNPs, and other psychiatric providers, this resource supports independent learning and ongoing clinical reference. Log in after enrollment to access the recording and study at your own pace. Use CASESTUDY100 at checkout to save $100 through October 10, 2026. Enroll: www.psychiatrymentorshipacademy.com/psychiatry-case-studies Learn more: www.psychiatrymentorshipacademy.com Thank you again to everyone who joined us. Keep learning, asking questions, and strengthening your clinical reasoning. #pmhnp #PMHNPStudent #nursepractitioner #therapist #nursepractitionerstudent

It’s happening tomorrow! Join us for a free, live, four-hour psychiatry case study masterclass. When clinical minds come together, the questions you ask, the experience you share, and the perspectives you bring make the learning more powerful. You’re not just attending. You’re bringing something valuable to the table. I’ll be presenting on perinatal psychiatry and how we can help bridge gaps in care. Together, we’ll work through realistic case studies across the lifespan, exploring diagnosis, differentials, treatment, risk and safety, level of care, and documentation. This is not four hours of simply listening. Come ready to think, participate, and learn alongside your colleagues. FREE 4-HOUR LIVE PSYCHIATRY CASE STUDY MASTERCLASS Sunday, September 27, 2026 | Live on Zoom 1:00–5:00 PM Arizona | 3:00–7:00 PM Central | 4:00–8:00 PM Eastern Register here: https://psychiatrymentorshipacademy.com/upcoming-events One-of-a-kind opportunity. Shared learning. Let’s think through them together. #PMHNP #PMHNPStudent #Psychiatrist #nurses #therapist

LIVE ON ZOOM THIS SUNDAY, September 27, 2026: FREE 4-HOUR PSYCHIATRY CASE STUDY MASTERCLASS We are officially just a few days away!!!! If you are a PMHNP, PMHNP student, new graduate, therapist, or other mental health professional, this is your reminder to secure your spot for our FREE 4-HOUR LIVE CASE STUDY MASTERCLASS. This is not a class where you simply sit and listen. Come ready to THINK, PARTICIPATE, and APPLY your clinical knowledge to realistic psychiatric cases. From Pregnancy to Geriatrics: Clinical Decision-Making Across the Lifespan We will work through cases involving: • Maternal and Perinatal Psychiatry • Child and Adolescent Psychiatry • Adult Psychiatry • Geriatric Psychiatry • Complex differential diagnoses • Psychopharmacology considerations • Risk and safety assessments • Clinical decision-making • Documentation and what should actually go into your note • Common documentation mistakes that can create problems later As we work through each case, challenge yourself: What is the most likely diagnosis? What belongs on my differential? What additional questions should I ask? What would I prescribe and WHY? What red flags can I NOT afford to miss? Can this patient safely be managed outpatient? When should I escalate care? What exactly should I document? THIS SUNDAY, SEPTEMBER 27, 2026 1:00 to 5:00 PM Arizona 3:00 to 7:00 PM Central 4:00 to 8:00 PM Eastern LIVE ON ZOOM Registration is completely FREE, but spots are LIMITED. We are only a few days away, so if you have been planning to attend, REGISTER NOW. Once we reach capacity, registration will close. Register here: https://psychiatrymentorshipacademy.com/upcoming-events Four hours. Multiple clinical cases. Every stage of life. One goal: helping you strengthen your clinical thinking and become a more confident psychiatric provider. Get registered, block your calendar, and come ready to participate. See you LIVE on Zoom this Sunday! #pmhnp #pmhnpstudent #nursepractitioner #nursepractitionerstudent #therapist

Structured training can help you connect diagnosis, differentials, psychopharmacology, treatment planning, monitoring, and real-world clinical decision-making. Our clinical psychiatry bootcamp includes complex clinical cases, psychopharmacology, differential diagnosis, treatment strategies, and downloadable clinical resources. Choose the format that works best for you: access the bootcamp as a pre-recorded program or join us for a live training experience. Ready to strengthen your clinical psychiatry skills? Enroll or learn more at: psychiatrymentorshipacademy.com You do not master psychiatry by memorizing more. You master it by learning to THINK CLINICALLY. #pmhnp #psychnp #pmhnpstudent #nursepractitioner #pmhnpmentor

From Pregnancy to Geriatrics: Clinical Decision-Making Across the Lifespan After the Lindsay Clancy case, I have noticed an important shift in conversations among psychiatric providers. Many providers are asking more questions about how to safely assess, diagnose, treat, and document psychiatric conditions during pregnancy and the postpartum period. What do you do when the presentation is complicated? What questions should you be asking? What red flags should change your plan? When should you escalate care? And perhaps just as importantly: How should you document your assessment and clinical decision-making? So I decided to host a FREE 4-HOUR LIVE CASE STUDY CLASS on Zoom! But we are not stopping with maternal psychiatry. We are going to work through realistic psychiatric case studies across the lifespan, including: • Maternal & Perinatal Psychiatry • Child & Adolescent Psychiatry • Adult Psychiatry • Geriatric Psychiatry • Complex differential diagnoses • Psychopharmacology considerations • Risk and safety assessment • Clinical decision-making • Documentation and what should actually go into your note • Common documentation mistakes that can create problems later This will NOT be four hours of simply listening to a lecture. We are going to work through cases together. I want you thinking: What is your diagnosis? What else is on your differential? What would you prescribe and why? What additional information do you need? Is this patient appropriate for outpatient management? What would you document? If you are a PMHNP, new graduate, PMHNP student, or psychiatric provider who wants to strengthen your clinical reasoning and documentation skills, this class is for you. 📅 Sunday, September 27, 2026 💻 LIVE on Zoom ⏰ 1:00–5:00 PM MST (Arizona) ⏰ 3:00–7:00 PM Central (CDT) ⏰ 4:00–8:00 PM Eastern (EDT) Registration is FREE, but spots are LIMITED. Please register ASAP to reserve your spot. Once we reach capacity, registration will close. REGISTER NOW: https://georgettesmentorshipacademy.mykajabi.com/offers/oFrQ5vG7 Come ready to think, participate, and work through cases with me. Four hours. Multiple cases. Every stage of life. One goal: becoming a stronger psychiatric provider. #pmhnp #pmhnpstudent #nursepractitioner #therapist #psychnp

If starting or growing your psychiatric private practice has been sitting on your “someday” list, here’s your reminder: you don’t have to figure everything out at once. Start with a ROADMAP. STEP 1: Define your practice model. Who do you want to serve? Medication management only or medication + psychotherapy? Telepsychiatry, in-person, or hybrid? Insurance, private pay, or both? STEP 2: Understand your state requirements. Know your scope of practice, independent/collaborative practice requirements, prescribing rules, telehealth requirements, and controlled-substance regulations. STEP 3: Build the business foundation. Determine the appropriate business structure, complete business registration, obtain the appropriate NPI(s), malpractice coverage, and DEA registration when applicable. STEP 4: Build your clinical infrastructure. Choose your EHR, scheduling system, HIPAA-compliant communication tools, intake forms, informed consents, and workflows. STEP 5: Create your policies BEFORE you need them. Think medication refills, controlled substances, no-shows, emergencies, after-hours communication, discharge, record retention, and more. STEP 6: Decide how you’ll get paid. Will you credential with insurance companies, remain private pay, or use a hybrid model? Understand credentialing timelines and start early if insurance is part of your plan. STEP 7: Build your visibility. Create a professional website, optimize your provider listings, develop your elevator pitch, and build referral relationships with therapists, PCPs, and community organizations. STEP 8: Plan for GROWTH. Starting is only part of the journey. Think about caseload capacity, burnout prevention, adding providers, transitioning from side practice to full-time, and eventually building a group practice if that is your goal. If you’re reading this thinking, “Okay…but I need someone to actually WALK ME THROUGH all of this,” that’s exactly why we created our Private Practice Startup & Marketing Intensive. Instead of spending months piecing together information from social media, you get a structured roadmap designed specifically for psychiatric providers. WHAT’S INCLUDED: • Full 7-hour pre-recorded intensive • 2 months of recording access • Comprehensive downloadable Private Practice Guide • Credentialing & insurance paneling education • 1099 vs. W-2 education • Credentialing Checklist • Common Credentialing Mistakes Guide • Practice Policies & Procedures Templates • Private Practice Startup Timeline • Psychiatric Evaluation & Follow-Up Templates • HIPAA + SEO Website Development Checklist • Professional Elevator Pitch Template • Referral Development Toolkit We cover everything from choosing your practice model and setting up your business to compliance, clinical operations, telepsychiatry, credentialing, marketing, referrals, risk management, and long-term growth. Total course value: $2,000 SPECIAL FIRST-YEAR COHORT PRICE: $599 If 2026 is the year you stop saying “one day” and start building the psychiatric practice you’ve been thinking about, give yourself a roadmap. ENROLL IN THE PRE-RECORDED PRIVATE PRACTICE STARTUP & MARKETING INTENSIVE. www.psychiatrymentorshipacademy.com Start. Build. Market. Grow. Email: [email protected] #privatepractice #pmhnp #psychiatrist #nursepractitioner #therapist

When people think about auditory hallucinations, they may imagine someone hearing a voice coming from across the room. But auditory hallucinations can be experienced in different ways. A person may hear a voice that seems to come from outside their head, such as from behind them, beside them, across the room, or somewhere else in their environment. Another person may experience a voice as coming from inside their head. Some people experience both. Research on auditory verbal hallucinations shows that voices can be perceived as internal, external, or sometimes difficult to localize. Where the voice seems to come from does not, by itself, tell us the diagnosis or how clinically significant the experience is. And this is important: A voice experienced inside the head should not automatically be dismissed as “just a thought.” At the same time, not every unwanted thought or internal experience is a hallucination. Intrusive thoughts, normal inner speech, trauma-related experiences, dissociative symptoms, and auditory hallucinations can sometimes be described in similar language. That is why assessment matters. CLINICAL PEARL FOR HEALTHCARE PROVIDERS When a patient says, “I’m hearing voices,” don’t stop at that question. Explore the experience. Ask: • “Does it feel like your own thoughts, or like a distinct voice?” • “Does the voice seem to come from inside your head or somewhere around you?” • “Do you recognize whose voice it is?” • “What does the voice say?” • “How often does this happen?” • “How much control do you feel you have over the experience?” • “Can you ignore or resist what the voice says?” • “Does the voice ever give you commands?” • “Has it told you to hurt yourself or someone else?” • “Has it said anything about your baby or your other children?” • “Do you feel that you have to do what the voice tells you?” • “How frightened or distressed are you by the experience?” Then assess the bigger picture. Is the patient also experiencing delusions, paranoia, severe mood symptoms, confusion, disorganization, impaired reality testing, significant insomnia, substance use, medication effects, or a possible medical or neurological condition? The location of a hallucination should never be used by itself to determine diagnosis, severity, or risk. WHY THIS MATTERS IN POSTPARTUM PSYCHIATRY Postpartum psychosis is rare, but it is a psychiatric emergency. Symptoms can include hallucinations, delusions, paranoia, severe mood symptoms, confusion, disorganization, insomnia, and impaired insight. Symptoms can develop rapidly, and some psychotic beliefs or hallucinations may involve the infant. Command auditory hallucinations can also occur, including voices directing a mother to harm herself or her infant, which makes careful and immediate risk assessment critical. So simply asking, “Are you hearing voices?” is not enough. Providers need to understand: What is the patient hearing? What does the voice mean to them? Is it giving commands? Is the infant involved? Is reality testing impaired? Can the patient resist the commands? And most importantly, is the patient or anyone else in immediate danger? When postpartum psychosis is suspected, this should not be managed as a routine outpatient follow-up. Urgent psychiatric and medical evaluation is warranted, and hospitalization is often required to protect the mother and infant while diagnostic evaluation and treatment begin. Hearing a voice is a symptom. Understanding the experience, the clinical context, and the risk behind it is where the assessment begins. Educational Disclaimer: This content is for educational and informational purposes only and is not intended to diagnose, treat, or provide individualized medical advice. #PostpartumPsychosis #AuditoryHallucinations #PMHNP #Psychiatry #psychiatrist

1. Never Stop Learning Mentor Note: Boards are the beginning, not the end. 2. Master the Assessment Mentor Note: Don’t prescribe before you understand the patient. 3. Think Beyond the Diagnosis Mentor Note: Always consider your differentials. 4. Know Your Medications WELL Mentor Note: Know why you’re prescribing—not just what. 5. Treat the Patient, Not the Score Mentor Note: Screening tools support your assessment; they don’t replace it. 6. Get Comfortable Saying “I Don’t Know” Mentor Note: Then research, consult, or refer. 7. Find a Great Mentor Mentor Note: You don’t have to figure everything out alone. 8. Document Like It Matters Mentor Note: Your note should tell the clinical story. 9. Know When to Escalate Care Mentor Note: Good judgment includes recognizing your limits. 10. Stay Teachabl, Even When Experienced Mentor Note: Confidence should never replace curiosity. Great PMHNPs Never Stop Growing. Learn. Ask. Consult. Improve. Clinical Psychiatry Bootcamp + 1:1 PMHNP Mentorship LEARN MORE → www.psychiatrymentorshipacademy.com #pmhnp #nursepractitionerstudent #psychnp #nurses #pmhnpmentor

The truth is: often, they don’t. PMHNPs may care for patients with the same psychiatric diagnoses, the same complex presentations, and many of the same clinical challenges psychiatrists encounter. But there is an important difference we should acknowledge: Psychiatrists receive substantially more extensive medical education and years of specialty residency training in psychiatry. So what should that mean for us as PMHNPs? Never stop learning. Not because we are trying to become psychiatrists. We are not. But because the patients who walk through our doors can still be incredibly complex. You may encounter treatment-resistant depression. Bipolar disorder. Psychosis. Suicidality. Substance use disorders. ADHD with multiple comorbidities. Complex medication regimens. Medical conditions that mimic psychiatric illness. And patients whose diagnoses are not immediately clear. Our differences in training should never make us feel “less than.” They should remind us of the responsibility that comes with our role. Your education should not stop when you graduate. It should not stop when you pass boards. And it certainly should not stop because you have been practicing for years. Keep learning. Keep strengthening your clinical judgment. Know your scope. Know your limitations. And know when consultation, collaboration, or a higher level of care is needed. That commitment to lifelong learning is one of the reasons we created Georgette’s Learning & Mentorship Academy. Our Clinical Psychiatry Bootcamp helps PMHNPs strengthen practical clinical skills in psychiatric assessment, differential diagnosis, psychopharmacology, treatment planning, documentation, billing, and the management of complex psychiatric presentations. And our One-to-One PMHNP Mentorship Program provides personalized support from an experienced mentor to help you navigate clinical questions, de-identified cases, documentation, career development, private practice, and the realities of practicing as a psychiatric provider. Because the goal is not to know everything. The goal is to never become so comfortable that you stop recognizing what you still need to learn. Stay curious. Stay teachable. Keep studying. Keep asking questions. Keep growing. Because your patients deserve a provider who never stops becoming better. Invest in your clinical growth. Explore our Clinical Psychiatry Bootcamp and One-to-One PMHNP Mentorship Program. LEARN MORE & ENROLL TODAY www.psychiatrymentorshipacademy.com #pmhnp #psychnp #nursepractitioner #nursepractitionerstudent #nurses

Recognizing postpartum psychosis as an emergency is only the beginning. What happens next? Once a postpartum patient is experiencing severe psychosis, what does evidence-based treatment actually look like? When should an antipsychotic be used? Why does lithium come up so often in the postpartum psychosis literature? When should ECT be considered, and could waiting too long for a medication to work create additional risk? And one of the most difficult questions: If a patient is severely psychotic, is it enough for her family to promise they will watch her around the clock? In Part 6B of my Lindsay Clancy educational series, we move from recognizing the emergency to treating it. We discuss: • The role of antipsychotics in acute treatment • Why lithium deserves serious consideration in postpartum psychosis and bipolar-spectrum illness • What the often-cited 98% remission rate from a stepwise treatment study actually means and what it does not mean • The monitoring required when lithium is prescribed • Breastfeeding, infant considerations, and the importance of protecting maternal sleep • When ECT may be appropriate and potentially lifesaving • Why rapid treatment matters when illness is severe • Why family support and family supervision are not the same as psychiatric hospitalization • Why a verbal promise of safety may be unreliable when reality testing is significantly impaired • What hospitalization provides beyond simply administering medication One of the most important clinical lessons is this: “Her family will watch her” does not automatically mean she is safe to go home. Family involvement can be incredibly valuable. But severe psychosis can impair insight, judgment, the ability to recognize danger, and the ability to reliably participate in a safety plan. When active psychosis, command hallucinations, severe mania, suicidality, dangerous delusions, confusion, or significant disorganization are present, clinicians have to ask a bigger question: Is outpatient treatment still an appropriate level of care? Postpartum psychosis is rare, but when it occurs, the clinical picture can change rapidly. Early recognition matters. Treatment matters. Lithium can matter. ECT can matter. Hospitalization can matter. Care coordination and family education matter. But above all: Safety comes first. Watch Lindsay Clancy Case — Part 6B for this important discussion. The Lindsay Clancy trial remains ongoing. This series is strictly educational. I am not diagnosing Lindsay Clancy, determining whether any clinician was negligent, or offering an opinion regarding criminal responsibility. #LindsayClancy #postpartumpsychosis #pmhnp #psychiatrist #therapist

The Lindsay Clancy case raises a critical question for every psychiatric provider: What should happen when a postpartum patient’s symptoms become increasingly concerning, and possible psychosis enters the clinical picture? At what point is another medication adjustment or routine follow-up no longer enough? In Part 6A of my Lindsay Clancy educational series, we move from recognizing the warning signs to discussing what providers should actually do when postpartum psychosis or another severe psychiatric illness is suspected. We’ll discuss: • Why suspected postpartum psychosis is a psychiatric emergency • Warning signs that should trigger immediate escalation • Why asking only, “Are you suicidal?” is not enough • Assessing thoughts, delusions, or hallucinations involving the infant or other children • Why collateral information from family can completely change a risk assessment • When care coordination becomes a safety intervention • When outpatient treatment may no longer be the appropriate level of care • Why medical, neurological, substance-related, and medication-related causes must also be considered • When psychiatric hospitalization becomes necessary • Why a verbal promise of safety may not be enough when reality testing is significantly impaired One of the most important questions in high-risk postpartum psychiatry may not be: “What medication should I change next?” It may be: “Is this patient still appropriate for outpatient management?” This episode is an important one for PMHNPs, psychiatrists, nurses, therapists, and other clinicians caring for postpartum patients. Watch Lindsay Clancy Case — Part 6A before Part 6B, where we’ll move into the acute treatment of postpartum psychosis, including antipsychotics, lithium, ECT, breastfeeding considerations, and the limitations of relying on family supervision at home during severe psychosis. The Lindsay Clancy trial remains ongoing. This series is strictly educational and is not intended to diagnose Lindsay Clancy, determine whether any clinician was negligent, or offer an opinion regarding criminal responsibility. #pmhnp #psychiatrist #therapist #lindsayclancy #nursepractitioner

• Generate detailed clinical notes • Suggest possible diagnoses with clinical rationale • Generate differential diagnoses • Suggest medications and dosages with rationales for clinician consideration • Develop treatment plans • Generate add-on psychotherapy documentation • Suggest relevant laboratory testing • Identify ICD-10 and billing codes • Create patient education and instructions • Answer clinical questions with evidence-based information • And so much more You remain the clinician. Companion supports you, but it does not replace your professional clinical judgment. Once your note is complete, simply review it, make any necessary edits, and copy and paste it into your EHR or patient record. And yes, Companion Medical Scribe AI is HIPAA compliant and can be used across multiple medical specialties. The goal is simple: spend more of the visit focused on your patient and less of your time after hours trying to finish documentation. Your documentation matters. Your time matters. Having the right tools can make a difference. Ready to see what Companion can do? Start your free trial today at: www.companionscribeai.com #pmhnp #nursepractitioner #physician #medicalscribe #dancemoms

The Lindsay Clancy case has opened an important conversation for every clinician who treats mental illness: How prepared are we to recognize and manage mental health conditions during pregnancy and the postpartum period? Perinatal mental health is not a niche area of psychiatry. Depression, anxiety disorders, OCD, bipolar disorder, and other psychiatric conditions can occur or worsen during pregnancy and after delivery. Although postpartum psychosis is rare, it is a psychiatric emergency requiring immediate assessment and appropriate intervention. One of the most important lessons for providers is that pregnancy or the postpartum period should not automatically mean stopping psychiatric treatment. Current clinical guidance emphasizes individualized risk-benefit assessment, weighing the potential risks of treatment against the risks of untreated or undertreated psychiatric illness, relapse, functional impairment, and medication discontinuation. And when a provider does not feel comfortable managing a pregnant or postpartum patient, the answer should not simply be, “I don’t treat pregnancy or postpartum.” Know your scope and limitations, but also know how to recognize red flags, coordinate care, obtain appropriate consultation, make a warm referral, and escalate to emergency or higher-level care when clinically indicated. Psychiatrists, PMHNPs, NPs, PAs, OB/GYNs, midwives, family medicine providers, pediatric clinicians, therapists, nurses, and primary care providers can all play a role in recognizing maternal mental health concerns. Maternal mental health is mental health. We need to keep learning. The Lindsay Clancy trial is ongoing. Her individual diagnosis, treatment, and legal responsibility should not be inferred from general information about perinatal mental health. This content is for healthcare professional education and awareness. #lindsayclancycase #pmhnp #psychiatrist #nursepractitioner #maternalmentalhealth

When clinical documentation is later reviewed, every detail can matter. But healthcare providers also know the reality: you are trying to listen carefully, assess thoroughly, develop a treatment plan, educate your patient, make clinical decisions, and somehow document everything accurately, often while seeing patient after patient. That is exactly where Companion Medical Scribe AI can help. Companion is more than an AI scribe. It is designed to support healthcare professionals across different medical specialties. In seconds, Companion can help you: • Generate detailed clinical notes • Suggest possible diagnoses with clinical rationale • Generate differential diagnoses • Suggest medications and dosages with rationales for clinician consideration • Develop treatment plans • Generate add-on psychotherapy documentation • Suggest relevant laboratory testing • Identify ICD-10 and billing codes • Create patient education and instructions • Answer clinical questions with evidence-based information • And so much more You remain the clinician. Companion supports you, but it does not replace your professional clinical judgment. Once your note is complete, simply review it, make any necessary edits, and copy and paste it into your EHR or patient record. And yes, Companion Medical Scribe AI is HIPAA compliant and can be used across multiple medical specialties. The goal is simple: spend more of the visit focused on your patient and less of your time after hours trying to finish documentation. Your documentation matters. Your time matters. Having the right tools can make a difference. Ready to see what Companion can do? Start your free trial today at: www.companionscribeai.com #pmhnp #psychiatrist #nursepractitioner #physician #physicianassistant

In this exchange, defense attorney Kevin Reddington questions psychiatrist Dr. Jennifer Tufts about whether she obtained Lindsay Clancy’s records from other clinicians and treatment settings. During her testimony, Dr. Tufts acknowledged that she did not have Clancy’s complete outside medical records. Now, I want to be very careful here. The fact that a psychiatrist did not obtain outside records does not, by itself, establish negligence. And we should not use one portion of courtroom testimony to determine whether a clinician met or failed to meet the standard of care. But for psychiatric providers, this exchange raises a very important clinical question: When should we look beyond what the patient is telling us and obtain additional information? AND THIS BRINGS US TO CARE COORDINATION The medication timeline we discussed in Part 5A begins to tell us something else. It identifies multiple clinicians and treatment settings. That is not inherently inappropriate. Patients appropriately transition between outpatient psychiatry, emergency departments, hospitals, specialty programs, and other clinicians. But every transition creates an opportunity for information to become fragmented. One clinician may know about a medication change. Another may know about an emergency department visit. Another may know about suicidal thoughts. A family member may have observed major behavioral changes at home. And the patient may not remember, recognize, or communicate every clinically relevant detail during one appointment. That is why continuity and coordination matter. CLINICAL PEARL NUMBER ONE Patient self-report is essential, but sometimes it is not enough. Mentor comment: This does not mean we distrust our patients. It means we recognize the limitations of any single source of clinical information. When clinically indicated and legally permissible, outside records, discharge summaries, medication histories, pharmacy information, and collateral information can help complete the picture. CLINICAL PEARL NUMBER TWO The more fragmented the treatment history, the more important medication reconciliation becomes. And medication reconciliation means more than clicking: “Medication list reviewed.” I want to know: Are you actually taking this medication? What dose? How often? When did you last take it? Who prescribed it? Why was it prescribed? Did it help? Did you experience side effects? What changed after you started it? Was another medication supposed to replace it? Are you taking anything PRN? Did another clinician prescribe something? What have you recently stopped? And are medications still appearing in your chart that you are no longer taking? That is meaningful medication reconciliation. CLINICAL PEARL NUMBER THREE A medication list can tell you what was prescribed. It cannot necessarily tell you what was taken. Mentor comment: Prescription history, dispensing history, patient report, collateral information, and actual adherence are different pieces of evidence. Do not automatically treat them as interchangeable. CLINICAL PEARL NUMBER FOUR Recent hospitalization or emergency psychiatric treatment should make you ask: What happened there? What diagnosis was considered? Why was the patient admitted? Why were they discharged? What medications were started, stopped, or changed? What symptoms improved? What symptoms remained? What was the recommended follow-up? And what safety plan was established? Mentor comment: A discharge medication list alone may not tell you the clinical reasoning behind the hospitalization. The discharge summary and other relevant records may provide context that a medication list cannot. DIFFERENT PROVIDERS MAY SEE DIFFERENT PARTS OF THE STORY This is especially important in psychiatry. A patient may appear relatively organized during a 20- or 30-minute appointment while family members are observing something very different at home. Symptoms can fluctuate. #lindsayclancystory #pmhnp #jennifertufts #psychiatrist #nursepractitioner

In Episode 5 Part A, we go one step deeper by looking at medication classes, doses, likely indications, overlap versus replacement, and the real clinical questions providers should ask. From sleep medications like zolpidem, to benzodiazepines, to quetiapine and lamotrigine, and then the January 2023 changes, we focus on what matters clinically. Pearl of the day: A medication appearing days before an event does not establish causation. What matters most is the clinical picture during that window, including baseline symptoms, what was targeted, what changed afterward, and what the follow up plan was. Educational only. Not medical or legal conclusions. CLINICAL PEARLS FOR PSYCHIATRIC PROVIDERS WITH MENTOR COMMENTS INTERPRETING PRESCRIPTION TIMELINES Pearl: A medication name plus dose plus date does not equal what the patient was taking or what the prescriber intended. Mentor comment: Treat the timeline as a hypothesis generator. Verify with symptoms, adherence, and context instead of concluding from paperwork. Pearl: When multiple medications appear sequentially, especially within the same class, reconstruct the likely switching pattern. Mentor comment: Map the clinical workflow. Scheduled versus PRN use, overlap, tapering speed, and frequency determine risk and meaning. ZOLPIDEM (AMBIEN) Pearl: Zolpidem is primarily a sleep medication and does not independently treat bipolar mania or primary psychosis. Mentor comment: Sleep can be a target, but insomnia treatment does not replace mood and psychosis stabilization when those diagnoses are in play. Pearl: Persistent severe insomnia should prompt reassessment of diagnosis and the overall clinical picture. Mentor comment: If insomnia will not respond, ask why. Consider wrong target symptoms, insufficient mood or anxiety control, substance effects, medical contributors, and adherence barriers. Pearl: Zolpidem can cause sedation and memory impairment and carries a boxed warning for rare but serious complex sleep behaviors. Mentor comment: Risk awareness matters. Still, timelines do not prove causation. BENZODIAZEPINES: LORAZEPAM, CLONAZEPAM, DIAZEPAM Pearl: Multiple benzodiazepines on a timeline can reflect replacement, overlap, tapering, or changing clinical urgency. It does not automatically mean simultaneous use. Mentor comment: The pattern matters. Frequency, overlap, and taper speed determine whether sedation or withdrawal risk is clinically plausible. Pearl: Abrupt discontinuation or rapid reduction after regular exposure can produce withdrawal symptoms. Mentor comment: Withdrawal can mimic psychiatric deterioration. Follow up and taper planning should be treated as part of treatment quality. QUETIAPINE (SEROQUEL) Pearl: Quetiapine dosing changes should be interpreted through context and indication. Mentor comment: A low dose may be used for sedation. Dose on paper does not confirm a treatment strategy targeting psychosis. Pearl: Timeline dose does not confirm adherence, duration taken, formulation, or response. Mentor comment: Tie the medication change to clinical outcomes. Sleep, mood, anxiety, and presence or absence of psychotic symptoms provide the evidence. LAMOTRIGINE Pearl: Lamotrigine is used for maintenance treatment of bipolar I disorder. It is not established as a rapid acute mania treatment, and titration matters. Mentor comment: A low titration dose does not equal therapeutic mood stabilization. Ask whether it was actually taken long enough to matter. Pearl: Faster titration increases the risk of serious rash, so start and titration timing are clinically relevant to interpretation. Mentor comment: Medication pharmacology and treatment timeline both need to align with the clinical story. BUSPIRONE AND DIPHENHYDRAMINE Pearl: Buspirone generally requires consistent administration and is not an immediate rescue for acute escalation. Diphenhydramine is sedating but is not a treatment for mania or psychosis. #lindsayclancystory #pmhnp #psychiatrist #pmhnpstudent #nursepractitioner

Georgette’s Learning and Mentorship Academy Whether you are a PMHNP student preparing for practice, a new graduate building clinical confidence, or a PMHNP who has been practicing for years and wants to sharpen your clinical skills, there is always another level of clinical growth. 1. Build Real Clinical Confidence Move beyond memorization and strengthen your ability to assess, diagnose, and develop appropriate treatment plans. MENTOR COMMENT: Students need a strong foundation. New grads need confidence. Experienced PMHNPs need opportunities to refine and update their clinical skills. 2. Strengthen Your Psychiatric Assessments Learn what questions to ask, what you should not miss, and how to organize a comprehensive psychiatric evaluation. MENTOR COMMENT: The quality of your treatment plan depends heavily on the quality of the assessment that comes before it. 3. Sharpen Your Psychopharmacology Knowledge Strengthen your understanding of medication selection, dosing, monitoring, side effects, interactions, and clinical considerations across different populations. MENTOR COMMENT: It is not enough to know which medication treats a disorder. Understand why you are choosing that medication for that specific patient. 4. Improve Your Differential Diagnoses Learn to recognize overlapping symptoms, identify important rule-outs, and avoid prematurely settling on one diagnosis. MENTOR COMMENT: Clinical reasoning improves when you consistently ask, “What else could this be?” 5. Learn Through Real Clinical Scenarios Practice applying your knowledge to the complex presentations PMHNPs encounter in real-world psychiatric practice. MENTOR COMMENT: Real patients do not always present like textbook examples. Strong clinicians learn to recognize patterns while considering the entire clinical picture. 6. Improve Your Documentation & Clinical Reasoning Strengthen how you document assessments, diagnoses, risk, treatment decisions, and follow-up plans. MENTOR COMMENT: Your documentation should tell the clinical story and demonstrate the reasoning behind your decisions. 7. Strengthen Your Approach to High-Risk Situations Build your knowledge around suicidal ideation, psychosis, mania, substance use, safety planning, and other complex psychiatric presentations. MENTOR COMMENT: High-risk psychiatry requires thoughtful assessment, clinical judgment, appropriate intervention, documentation, and follow-up. 8. Bridge the Gap Between School & Practice Learn practical clinical skills that may not receive enough attention during traditional PMHNP education. MENTOR COMMENT: Passing boards is an important milestone, but becoming a strong psychiatric clinician requires continued application, feedback, and experience. 9. Keep Growing Even If You Have Been Practicing for Years This program is not only for beginners. Experienced PMHNPs can use the Bootcamp to refresh knowledge, identify clinical gaps, sharpen decision-making, and strengthen areas where they want more confidence. MENTOR COMMENT: Years in practice do not eliminate the need for continued learning. Psychiatry evolves, evidence changes, and strong clinicians continue sharpening their skills. 10. Get Ongoing Mentorship The Bootcamp provides structured education. Mentorship helps support you as you apply what you are learning. Discuss de-identified clinical scenarios, ask questions, and continue learning from experienced psychiatric providers. MENTOR COMMENT: You do not have to wait until you are struggling to seek mentorship. Mentorship can be part of intentional professional growth at every stage of your career. 11. Get Paired With a Mentor Through Georgette’s Learning and Mentorship Academy, you can connect with a mentor who can help support your individual learning and professional development. MENTOR COMMENT: Your learning needs are personal. Having a mentor gives you Continue growing through our Mentorship Program. Learn more: www.psychiatrymentorshipacademy.com #pmhnp #pmhnpstudent #nursepractitioner #nursepractitionerstudent #psychnp

One missing word can completely change the meaning of a psychiatric note. During testimony in the ongoing Lindsay Clancy trial, psychiatrist Dr. Jennifer Tufts was questioned about documentation that reportedly read: “Not hyper, pressured speech.” Dr. Tufts testified that what she intended to document was: “Not hyper, not pressured speech.” That single missing word, “not,” creates two very different clinical interpretations. For psychiatric providers, this courtroom exchange offers an important lesson about psychiatric documentation, mental status examinations, risk assessment, and clinical reasoning. In this video, I break down 7 documentation lessons every psychiatric provider should consider, including: • Clearly documenting whether psychiatric symptoms are present or absent • Distinguishing insomnia from decreased need for sleep • Separating patient-reported symptoms from clinician observations • Providing context for mania, psychosis, SI/HI, intrusive thoughts, and other significant findings • Avoiding ambiguous shorthand • Reviewing high-risk documentation before signing • Documenting the clinical reasoning behind your assessment and treatment plan Good psychiatric documentation is not about writing the longest note. It is about creating a clear, accurate, specific, and clinically meaningful record that tells the patient’s clinical story. Your note may eventually be reviewed by another provider, a hospital, a licensing board, an attorney, an expert witness, or a jury. The question is: Would they understand exactly what you meant from your documentation alone? The Lindsay Clancy trial remains ongoing as of August 2026, and additional testimony or evidence may provide further context. This content is strictly for education and awareness and should not be interpreted as determining that any provider made a clinical error, establishing negligence, diagnosing Lindsay Clancy, or determining criminal responsibility. Follow for more evidence-based psychiatric education and lessons psychiatric providers can apply to clinical practice. #lindsayclancy #pmhnp #psychiatrist #nurses #nursepractitioner

13 psychiatric medications. More than 30 reported prescriptions. Roughly four months. At first glance, Lindsay Clancy’s reported medication timeline may immediately raise concerns about polypharmacy. But for psychiatric providers, counting medications is not enough. The questions that matter are: What was she actually taking? What had been discontinued? What was PRN? What replaced what? Were medications overlapping? Was she taking them consistently? And most importantly, how did her symptoms change as the medications changed? A prescription history is not the same as an active medication list, and an active medication list is not necessarily the same as actual medication exposure. This case also highlights another important clinical principle: medication changes are clinical data. When symptoms persist, worsen, or change despite treatment, our job is not always to simply ask, “What medication should we try next?” Sometimes we need to ask: “Do I need to reassess the entire clinical picture?” The reported timeline also raises important teaching questions about antidepressants, sedating medications, benzodiazepines, mood stabilizers, antipsychotics, and especially sleep. Because insomnia is a symptom, not a diagnosis. And being exhausted but unable to sleep is not the same clinical presentation as having a decreased need for sleep. In Part 4 of my Lindsay Clancy educational series, I break down this medication timeline and discuss what psychiatric providers can learn from it without assuming that prescription equals ingestion, medication changes equal inappropriate treatment, or timing equals causation. The biggest takeaway: Don’t just count the medications. Reconstruct the clinical story. And in Part 5, we’re going deeper into the medications that repeatedly appear in the timeline and what was happening in January 2023, leading up to January 24, 2023. The Lindsay Clancy trial is ongoing as of August 2026. Details may change as additional evidence and testimony emerge. This content is for education and awareness only and is not intended to independently diagnose Lindsay Clancy, determine criminal responsibility, establish negligence, or conclude whether treatment met the standard of care. #lindsayclancy #pmhnp #psychiatrist #therapist #pmhnpstudent

One common assumption is that a violent act should always have been predictable and that if tragedy occurs, a psychiatric provider must have missed an obvious warning sign. In reality, violence risk assessment is far more complex. Psychiatric providers evaluate factors such as: • Previous violence or threatening behavior • Current suicidal or homicidal thoughts • Intent, planning, and access to lethal means • Psychosis, paranoia, or command hallucinations • Mania, agitation, impulsivity, or severe insomnia • Substance use • Recent deterioration in mood or functioning • Treatment adherence and response • Collateral information from family or other sources • Protective factors, supports, and willingness to accept care These assessments help clinicians identify, estimate, and manage risk. They cannot predict an individual’s future behavior with certainty. A patient’s denial of suicidal or homicidal ideation is important, but it does not complete the assessment. Providers may need to ask: • Are the thoughts unwanted and frightening? • Does the patient believe the thoughts are true? • Is there intent, planning, or preparation? • Are voices giving commands? • Are delusions centered on the child? • Has sleep, judgment, behavior, or functioning recently changed? Intrusive thoughts associated with postpartum OCD are typically unwanted, distressing, and inconsistent with the patient’s values. Psychosis may involve hallucinations, fixed false beliefs, impaired reality testing, or a belief that a dangerous action is necessary or protective. These presentations require different risk assessments and treatment plans. Risk is also dynamic. A reassuring assessment today does not guarantee that risk will remain unchanged tomorrow. Clinically meaningful changes in sleep, symptoms, functioning, behavior, insight, or access to lethal means should prompt reassessment. The trial is ongoing, and the public does not yet have every clinical record, assessment, or piece of testimony. It would therefore be premature to conclude from social media reports alone that a particular provider either caused the tragedy or could have predicted it with certainty. Regardless of the legal outcome, this case highlights the importance of comprehensive assessment, thoughtful documentation, appropriate collateral information, close follow-up, and immediate intervention when postpartum psychosis or another psychiatric emergency is suspected. Clinical Pearls • Violence risk assessment estimates risk. It does not predict future behavior with certainty. • A simple “denies SI/HI” statement is not a substitute for a comprehensive assessment when other warning signs are present. • Explore the content, meaning, frequency, controllability, intent, and associated beliefs behind thoughts of harm. • Distinguish unwanted intrusive thoughts from delusions, hallucinations, and command hallucinations. • Assess changes in sleep carefully. Inability to sleep because of anxiety is different from a decreased need for sleep associated with mania. • Document the information available, your clinical reasoning, protective factors, safety planning, consultations, and follow-up recommendations. • Psychiatric illness alone does not make someone violent. Every patient deserves an individualized assessment without reinforcing stigma. Question Do you think psychiatric providers can truly predict who will become violent, or can we only assess and manage risk using the information available at the time? #lindsayclancystory #pmhnp #psychiatrist #nursepractitioner #mentalhealthawareness

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Introducing Our One-to-One PMHNP Clinical Mentorship Program One of the biggest challenges in psychiatric practice is not having someone to turn to when you encounter a difficult patient case, an unfamiliar diagnosis, or a challenging medication decision. Sometimes, all you need is an experienced provider to discuss a case with, validate your clinical reasoning, or help guide your next steps. That's exactly why we created this program. Unlike traditional group mentorship programs, you will be personally matched with an experienced PMHNP or psychiatric provider who becomes your dedicated mentor—someone you can email, message, or meet with for real-world clinical guidance as you care for your patients. Whether you are: • A PMHNP student preparing for clinical practice • A new graduate starting your first PMHNP position • An experienced PMHNP looking for additional clinical support • A psychiatric provider wanting to strengthen your diagnostic and treatment skills This program was designed with you in mind. What Makes This Mentorship Different? • You are assigned your own dedicated mentor, not a rotating group of instructors. • You continue working with the same mentor for as long as you remain enrolled, allowing you to build a trusted professional relationship with someone who understands your learning style, practice setting, and professional goals. • You'll have the reassurance of knowing you're never practicing alone. Receive Guidance On: • Psychiatric diagnosis • Differential diagnosis • Psychopharmacology and medication selection • Medication titration and switching strategies • Treatment planning • Challenging clinical cases • Documentation • Clinical decision-making • Psychotherapy integration • Everyday PMHNP practice questions • Learn more about the mentorship program • Choose the mentorship subscription that's right for you Visit www.psychiatrymentorshipacademy.com to learn more #pmhnp #pmhnpstudent #nursepractitioner #nursepractitionerstudent #psychnp

First, I am genuinely glad that this person recovered and that their children are safe. Their experience matters. But one person’s experience cannot define how an entire psychiatric illness presents in every patient. Most people who experience postpartum psychosis do not kill or seriously harm their children. With rapid recognition, emergency treatment, and continued follow-up, many patients recover. But postpartum psychosis remains a psychiatric emergency because it can involve severe mania, depression, confusion, disorganization, hallucinations, delusions, and profoundly impaired judgment. Symptoms, severity, insight, risk, and response to treatment can vary significantly from one patient to another. That does not mean postpartum psychosis should be viewed as a simple spectrum ranging from intrusive thoughts to violence. These symptoms must be carefully distinguished. A patient with postpartum OCD may experience frightening intrusive thoughts about harming the baby while recognizing that the thoughts are unwanted, irrational, and inconsistent with her values. She is usually distressed by the thoughts and does not want to act on them. A patient experiencing psychosis may have impaired reality testing. She may believe a delusion is true, believe harm is necessary or protective, or experience a hallucination commanding her to act. Those are very different clinical presentations and carry different levels of risk. That is why saying, “I had postpartum psychosis and did not harm my children, so someone else could not have been severely impaired,” is not clinically sound. It would be similar to saying: “My depression never made me suicidal, so another person’s depression could not have made them suicidal.” The same diagnosis does not guarantee the same symptoms, severity, level of insight, or outcome. At the same time, a diagnosis of postpartum psychosis does not automatically explain, excuse, or establish legal responsibility for a harmful act. Diagnosis, clinical risk, and criminal responsibility are separate questions. Every patient requires an individualized assessment that examines: The exact symptoms. The timing and progression of those symptoms. Sleep patterns. Mood symptoms. Reality testing. Insight. Suicidal or homicidal intent. Delusions involving the child. Command hallucinations. Access to means. Medication and substance exposure. Medical or neurological causes. Collateral information from family members. And the patient’s behavior before, during, and after the event. Regarding Lindsay Clancy, her trial remains ongoing as of August 3, 2026. Her defense argues that she was experiencing postpartum psychosis and was not criminally responsible. Prosecutors dispute that explanation and argue that her actions were deliberate. The court, not social media, will determine her criminal responsibility. My purpose is not to justify her alleged actions or decide the verdict. My purpose is to help psychiatric providers recognize severe postpartum illness, assess risk thoroughly, distinguish intrusive thoughts from psychosis, and intervene before a psychiatric emergency becomes a tragedy. Two truths can exist at the same time: Most mothers with postpartum psychosis never harm their children. And postpartum psychosis can still carry a serious risk of suicide, accidental harm, neglect, or infant harm when reality testing and judgment are severely impaired. Recognizing that risk is not stigmatizing every mother with postpartum psychosis. It is why suspected postpartum psychosis requires immediate psychiatric and medical evaluation. Understanding an illness is not the same as excusing an alleged act. And one survivor’s experience should never be used to invalidate another patient’s clinical presentation. #lindsayclancystory #pmhnp #psychiatrist #momsoftiktok #nursepractitioner

No psychiatric medication should be described as completely risk-free during breastfeeding. However, using psychiatric medication does not automatically mean that a mother must stop breastfeeding. Many psychiatric medications are compatible with breastfeeding when clinically indicated. Treatment decisions should be individualized by considering: • The mother’s diagnosis and psychiatric stability • Her previous response to treatment • The risks of relapse or untreated mental illness • The amount of medication transferred into breast milk • The infant’s age, gestational age, health and feeding pattern • Whether the infant is exclusively or partially breastfed • The availability of pediatric monitoring Current ACOG guidance recommends against withholding or discontinuing psychiatric medication solely because a patient is pregnant or breastfeeding. Important Clinical Principle Medication exposure through breast milk is generally lower than fetal exposure through the placenta during pregnancy. However, the amount of exposure varies considerably by medication. Newborns, premature infants and medically fragile infants may have a reduced ability to metabolize and eliminate medications. Providers must evaluate both the medication and the infant rather than assuming that all breastfeeding exposure carries the same level of risk. Mood Stabilizers Generally Compatible When Clinically Indicated Lamotrigine • Lamotrigine transfers into breast milk in clinically measurable amounts. • Infant serum concentrations may also be measurable. • Most breastfed infants exposed to lamotrigine do not experience adverse effects. • Breastfeeding may continue when lamotrigine is clinically necessary, particularly when it has maintained maternal stability. Monitor the infant for: • Rash • Excessive sleepiness • Poor feeding • Inadequate weight gain • Apnea or breathing difficulties • Unusual lethargy If the infant develops concerning symptoms, temporarily pause breastfeeding while the infant receives prompt medical evaluation. Infant serum lamotrigine concentrations, platelet counts and liver enzymes may be considered when symptoms occur, maternal doses are high or the infant is medically vulnerable. Routine laboratory testing is not required for every asymptomatic infant. Important Postpartum Consideration Lamotrigine clearance often increases substantially during pregnancy and then decreases rapidly following delivery. A dose that was increased during pregnancy may become excessive after childbirth. The maternal dose should be reassessed and reduced toward the pre-pregnancy dose when clinically appropriate. This helps prevent maternal toxicity and unnecessary infant exposure. Valproate Valproate is strongly avoided during pregnancy whenever possible because of its teratogenic and neurodevelopmental risks. However, pregnancy risk and breastfeeding risk are not the same. • Valproate transfers into breast milk in low amounts. • Infant serum concentrations are generally low or undetectable. • Valproate is generally considered compatible with breastfeeding when clinically indicated. Monitor the infant for: • Jaundice • Unusual bruising • Bleeding • Poor feeding • Excessive sleepiness Routine infant serum valproate levels are not generally necessary in a healthy, asymptomatic infant. Clinical Pearl Valproate is an important example of why pregnancy and lactation recommendations should not be used interchangeably. A medication may carry substantial fetal risk during pregnancy while producing very low infant exposure through breast milk. Carbamazepine • Carbamazepine and its active metabolite enter breast milk. • Most breastfed infants tolerate the exposure without significant adverse effects. • Carbamazepine is generally considered compatible with breastfeeding when clinically indicated. Monitor the infant for: • Excessive sedation • Poor feeding • Inadequate weight gain • Jaundice • Signs of liver dysfunction #pmhnp #psychiatrist #nursepractitioner #maternalmentalhealth #postpartumjourney

The Lindsay Clancy trial is still ongoing, and this discussion is based on publicly available information. The facts may change as additional evidence is presented. This discussion is strictly for educational purposes. #pmhnp #psychiatrist #nursepractitioner #postpartumpsychosis #nurses