poor sleep), recognition of postpartum psychosis may be difficult for providers and family-members to identify; thus, it is recommended that providers directly address thoughts of harm for both the patient and child. Differential The presentation of PPP includes a large differential overlapping neurological and psychiatric diseases and syndromes. Neurological, or cognitive, symptoms like disorientation and confusion raise concerns for conditions that organically affect the brain: this may include autoimmune processes resulting in various forms of encephalitis, embolism (and other vascular disorders), and infectious processes. Physical causes as a result of chronic hormonal disease (e.g., thyroid diseases, hyperparathyroidism) or complications resulting from childbirth, such as Sheehan's syndrome or other complications resulting from excess blood loss, should also be evaluated. Other psychiatric conditions must also be considered: postpartum blues, postpartum depression, anxiety disorders, and postpartum OCD may have many overlapping symptoms with PPP. Finally, psychosis as a result of various substances (including medications such as steroids), should be ruled out. If this is a first-onset episode of psychosis, new-onset bipolar disorder and schizophrenia cannot be ruled out; the diagnosis of these disorders is based on time and recurrence of episodes. Treatment While each case is considered by individual circumstances, generally, PPP is assessed as a psychiatric emergency and requires admission to a psychiatric hospital for close care. This admission may be to a mother-baby psychiatric unit or a general adult psychiatric unit, depending upon the availability in one's country and area. Because few units, especially in the United States, offer mother-baby services, patients may be discharged home as soon as the worst concerns for the safety of the patient and infant are cleared, even though the patient may still be experiencing some symptoms of PPP; in this way, patients receive care to prevent harm to self and others but return home to care for their child and promote bonding as soon as they are able. Treatment plans are made up of a combination of education, medication, and close follow-up care and support; the major goals of care include improving sleep and psychotic symptoms while helping to minimize major shifts in mood, such as depression and mania. Medical treatment typically involves ECT, benzodiazepines, lithium, and/or antipsychotics. Electroconvulsive Therapy (ECT) Beginning in 1938, ECT as a psychiatric treatment has been long-established and well-documented, leading to a large body of literature supporting its effectiveness and safety in various psychiatric conditions, including psychosis. Its availability prior