In perinatal mood and anxiety disorders

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Perinatal mood and anxiety: 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.

Psychiatric interviewing series

David Goldbloom and Nancy McNaughton demonstrate clinical interviewing situations.

Psychiatry in primary care toolkit

A powerful mobile app packed with features that will streamline screening and assessment in primary care.

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Frequently asked questions