Assessment​

Assessing "postpartum blues"

Between 50 and 85 per cent of women experience "postpartum blues". Key features include:

• transient, mild symptoms
• no loss of functionality
• self-limited to two weeks

No major intervention is required for postpartum blues.

Assessing depressive disorders

Screening

• Use the Edinburgh Postnatal Depression Scale, a validated self-rated tool 
• Screen at 28–32 weeks of gestation and again six to eight weeks postpartum.
• Frequently screen women from high-risk populations.

Clinician interview

• Review symptoms of depressive disorders outlined in the DSM.
• Take a personal psychiatric history and family psychiatric history.
• Assess premenstrual-, contraceptive- and seasonal-related mood changes.
• Assess suicidality.
• Exclude medical morbidity (e.g., anemia, thyroid, renal, hepatic disease).
• Assess substance use.
• Assess supports, including partner, family and social supports.
• Ask about bonding with the child, both during pregnancy and after.
• Observe maternal-infant interaction.

Assessing postpartum psychosis

• Rare occurrence (1–2 /1,000)
• Rapid development of delusions and hallucinations, labile mood and behaviour, and agitation in the first few weeks after delivery
• Psychiatric emergency that requires hospitalization
• Suicidal and homicidal potential
• Often the first presentation of bipolar disorder

Assessing anxiety disorders

All pre-existing anxiety disorders may worsen in the perinatal period.

Panic disorder

• This is the most common anxiety disorder presentation.
• Look for unusual or unrelated somatic complaints.
• Ask about ER and walk-in clinic visits.

Generalized anxiety disorder

• This diagnosis is commonly missed.
• Look for excessive worry ("What if …?"), constantly seeking reassurance, catastrophizing events.

Obsessive-compulsive disorder (OCD)

• This frightening condition often involves horrific intrusive thoughts of harming the baby or oneself.
• Reassure the patient, since the risk of acting on these thoughts is extremely small.
• Look for worsening of pre-existing OCD.