In this episode of the Podcast, Dr. David Puder sits down with reproductive psychiatrist Dr. Katie Unverferth, Director of the UCLA Women's Life Center and Medical Director of the UCLA Maternal Mental Health Program, to clarify the critical differences between common postpartum intrusive thoughts of infant harm, postpartum OCD, and true postpartum psychosis. They discuss how nearly all new mothers experience ego-dystonic thoughts of accidental or intentional harm, how to screen without triggering concealment, when severity and compulsions cross into OCD, the role of high-dose SSRIs plus exposure and response prevention (ERP), red-flag signs of ego-syntonic content, agitation, insomnia, and delirium-like states that signal psychosis, and the strong evidence for lithium prophylaxis and acute treatment in high-risk patients.