Abstract
This chapter serves as a blueprint to provide a framework for considerations in differential diagnosis and treatment recommendations for pregnant and postpartum patients. This chapter will cover various categories of possible psychiatric differential diagnoses in pregnant and postpartum patients, the process of the perinatal psychiatric consultation and general principles of psychiatric treatment in perinatal patients. Lastly, particular treatment considerations for patients along the reproductive span will be reviewed, including preconception counseling, pregnancy and postpartum visits.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Meltzer-Brody S. New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci. 2011;13(1):89–100.
ACOG, Screening for perinatal depression. 2016.
PSI. Screening recommendations. Available from: https://www.postpartum.net/professionals/screening/.
Cox J, Holden J, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.
Kroenke K, Spitzer RL, JBW W. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Moares GP, Lorenzo L, Pontes GA, Montenegro MC, Cantilino A. Screening and diagnosing postpartum depression: when and how? Trends Pscyhiatry Psychother. 2017;39(1):54–61.
Zhong Q, Gelaye B, Rondon M, Sanchez SE, Garcia PJ, Sanchez E, Barrios YV, Simon GE, Henderson DV, Cripe SM, Williams MA. Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. J Affect Disord. 2014;162:1–7.
Zhong Q-Y, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sanchez SE, Williams MA. Diagnostic validity of the Generalized Anxiety Disorder - 7 (GAD-7) among pregnant women. PloS One. 2015;10(4):e0125096.
Stern T. Massachusetts General Hospital handbook of general hospital psychiatry. 6th ed. Philadelphia: Saunders/Elsevier; 2010.
Poels EMP, Bijma HH, Galbally M, Bergink V. Lithium during pregnancy and after delivery: a review. Int J Bipolar Disord. 2018;6:26.
A S. Algorithm for lamotrigine dose adjustment before, during and after pregnancy. Acta Neurol Scand. 2012;126:e1–4.
Clark CT, Klein AM, Perel JM, Helsel J, Wisner KL. Lamotrigine dosing for pregnant patients with bipolar disorder. Am J Psychiatry. 2013;170(11):1240–7.
Bergink V, Armangue T, Titulaer M, Markx S, Dalmau J, Kushner SA. Autoimmune encephalitis in postpartum psychosis. Am J Psychiatry. 2015;172(9):901–8.
Baroud E, Hourani R, Talih F. Brain imaging in new onset psychiatric presentations. Innov Clin Neurosci. 2019;16(1–2):21–6.
Association, A.P. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychological Association; 1994.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.
Organisation, W.H., ICD-10 classifications of mental and behavioural disorder: clinical descriptions and diagnostic guidelines. 1992.
Gynecologists ACoOa. Committee opinion: screening for perinatal depression. Obstet Gynecol. 2018:757.
Stuebe A, et al. Failed lactation and perinatal depression: common problems with shared neuroendocrine mechanisms? J Women's Health. 2012;21(3):265–72.
Williamson JA, O'Hara MW, Stuart S, Hart KJ, Watson D. Assessment of postpartum depressive symptoms: the importance of somatic symptoms and irritability. Assessment. 2015;22(3):309–18.
Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27:791–802.
Gideon Koren GP. Pregnancy-associated changes in pharmacokinetics and their clinical implications. Pharm Res. 2018;35:61.
CfDCa, P., Breastfeeding among U.S. children born 2009-2016. CDC National Immunization Survey.
UK, U., UK Baby friendly breastfeeding initiative.
Meltzer-Brody SaIJ. Optimizing the treatment of mood disorders in the perinatal period. Dialogues Clin Neurosci. 2015;17(2):207–18.
Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010;303(19):1961–9.
Blazer DG, Kessler RC, KA MG, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994;151(7):979–86.
Meltzer-Brody S, Jones I. Optimizing the treatment of mood disorders in the perinatal period. Dialogues Clin Neurosci. 2015;17(2):207–18.
Postpartum Support International (PSI). Available from: http://www.postpartum.net/.
AC Viguera TW, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164(12):1817–24.
Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. Am J Psychiatry. 2012;169(6):609–15.
Yonkers K, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009;31:403–13.
Yonkers KA, Vigod S, Ross LE. Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Obstet Gynecol. 2011;117(4):961–77.
Yonkers K, et al. Antidepressant use in pregnant and postpartum women. Annu Rev Clin Psychol. 2014;10:369–92.
Meltzer-Brody S. Treating perinatal depression: risks and stigma. Obstet Gynecol. 2014;124(4):653–4.
Cohen L, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499–508.
Gaynes B, Gavin N, Meltzer-Brody S. Perinatal depression: prevalence, screening accuracy and screening outcomes. Evid Rep Technol Assess. 2005;119:1–8.
Jones I, Craddock N. Bipolar disorder and childbirth: the importance of recognising risk. Br J Psychiatry. 2005;186:453–4.
DiFlorio A, Forty L, Gordon-Smith K, et al. Perinatal episodes across the mood disorder spectrum. JAMA Psychiat. 2013;70(2):168–75.
Munk-Olsen T, Laursen TM, Mendelson T, Pedersen CB, Mors O, Mortensen PB. Risks and predictors of readmission for a mental disorder during the postpartum period. Arch Gen Psychiatry. 2009;66(2):189–95.
Jones IHJ. Puerperal psychosis. In: Kohen D, editor. The Oxford textbook of women’s mental health. Oxford: Oxford University Press; 2010.
Robertson E, Jones I, Haque S, Holder R, Craddock N. Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis. Br J Psychiatry. 2005;186:258–9.
Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry. 2001;158(6):913–7.
Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. Family and partner psychopathology and the risk of postpartum mental disorders. J Clin Psy. 2007;68(12):1947–53.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Cox, E. (2021). Approach to Perinatal Psychiatry. In: Cox, E. (eds) Women's Mood Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-71497-0_3
Download citation
DOI: https://doi.org/10.1007/978-3-030-71497-0_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-71496-3
Online ISBN: 978-3-030-71497-0
eBook Packages: MedicineMedicine (R0)