: Psychotic symptoms may emerge in up to 40% of people who misuse stimulants, with physiological changes in the perinatal period potentially contributing to the development of psychosis. In this report, we discuss the case of a woman presenting with stimulant misuse, psychosis, and obsessive compulsive disorder-like symptoms in the postpartum period. We describe the patient's symptoms at presentation, differential diagnoses, treatment course, and related challenges.