ifficult ethical situations can arise when treating perinatal women who have serious mental illness (SMI). Clinicians must consider ethical issues related to administering antipsychotic medications, the safety of breastfeeding, and concerns for child welfare. They need to carefully weigh the risks and benefits of each decision when treating perinatal women who have SMI. Ethical guidelines can help clinicians best support families in these situations. In this article, we describe 2 cases of women with psychotic disorders who requested to breastfeed after delivering their child during an inpatient psychiatric hospitalization. The course of their hospitalizations illustrated common ethical questions and facilitated the creation of a framework to assist with complex decision-making regarding breastfeeding on inpatient psychiatric units. Ms. C, age 41, is multigravida with a psychiatric history of chronic, severe schizoaffective disorder and lives in supportive housing. When Ms. C presents to the hospital in search of a rape kit, clinicians discover she is 22 weeks pregnant but has not received any prenatal care. Psychiatry is consulted because she is found to be intermittently agitated and endorses grandiose delusions. Ms. C requires involuntary hospitalization for decompensated psychosis because she refuses prenatal and

A pproximately 1 in 200 individuals will be diagnosed with schizophrenia in their lifetime. 1 DSM-5 criteria for the diagnosis of schizophrenia require the presence of ≥2 of 5 symptoms: delusions, hallucinations, disordered speech, grossly disorganized (or catatonic) behavior, and negative symptoms such as flat affect or avolition. 2 Multiple studies have found increased rates of cannabis use among patients with schizophrenia. Because cognitive deficits are the chief predictor of clinical outcomes and quality of life in individuals with schizophrenia, the cognitive effects of cannabis use among these patients are of clinical significance. 3 As legislation increasingly allows for the sale, possession, and consumption of cannabis, it is crucial to provide clinicians with evidence-based recommendations for treating patients who regularly use cannabis (approximately 8% of the adult population 3 ). In this article, we analyze several peer-reviewed studies to investigate the impact of cannabis use on the onset and development of schizophrenia. Schizophrenia is associated with several structural brain changes, and some of these changes may be influenced by cannabis use (Box, 4 page 44). The biochemical etiology of schizophrenia is poorly understood but thought to involve dopamine, glutamate, serotonin, and gamma-aminobutyric For some who are predisposed to psychosis, cannabis may trigger or exacerbate symptoms

Editor's note: Readers' Forum is a department for correspondence from readers that is not in response to articles in Current PsyChiatry. All submissions to Readers' Forum undergo peer review and are subject to editing for length and style.

Pearls ith the diagnosis of attentiondeficit/hyperactivity disorder (ADHD) on the rise 1 and a surge in prescriptions to treat the disorder leading to stimulant shortages, 2 ensuring that patients are appropriately evaluated for ADHD is more critical than ever. ADHD is a clinical diagnosis that can be established by clinical interview, although the results of neuropsychological testing and collateral information from family members are helpful. Assessing adults for ADHD can be challenging when they appear to want to convince the clinician that they have the disorder. In this article, I provide tips to help you accurately diagnose ADHD in adult patients.

Editor's note: Readers' Forum is a department for correspondence from readers that is not in response to articles published in Current PsyChiatry. All submissions to Readers' Forum undergo peer review and are subject to editing for length and style.

Pearls hildbirth-related posttraumatic stress disorder (CB-PTSD) is a form of PTSD that can develop related to trauma surrounding the events of giving birth. It affects approximately 5% of women after any birth, which is similar to the rate of PTSD after experiencing a natural disaster. 1 Up to 17% of women may have posttraumatic symptoms in the postpartum period. 1 Despite the high prevalence of CB-PTSD, many psychiatric clinicians have not incorporated screening for and management of CB-PTSD into their practice. This is partly because childbirth has been conceptualized as a "stressful but positive life event." 2 Historically, childbirth was not recognized as a traumatic event; for example, in DSM-III-R, the criteria for trauma in PTSD required an event outside the range of usual human experience, and childbirth was implicitly excluded as being too common to be traumatic. In the past decade, this clinical phenomenon has been more formally recognized and studied. 2 CB-PTSD presents with symptoms similar to those of other forms of PTSD, with some nuances, as outlined in Table 1 . 3 Avoidance can be the predominant symptom; this can affect mothers' engagement in postnatal care and is a major risk factor for postpartum depression. 3 Many risk factors in the peripartum period can impact the development of CB-PTSD (Table 2, 3 page 56 ). The most significant risk factor is whether the patient views the delivery of their baby as a subjectively negative experience, regardless of the presence or lack of peripartum complications. 1 However, parents of infants who require treatment in a neonatal intensive care unit and women who require emergency medical treatment following delivery are at higher risk.