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
- 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.
- 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.
- 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.
Psychiatry in primary care toolkit
The Psychiatry in Primary Care App has been decommissioned.
The revised print version of Psychiatry in Primary Care is avaible through the CAMH store.
Best practice guidelines for mental health disorders in the perinatal period (BC reproductive mental health program, 2014)
(NICE guideline CG192, 2014)