Text adapted from: "Perinatal mood and anxiety disorders," in Psychiatry in primary care by Ariel K. Dalfen (CAMH, 2019).
Pregnant women with psychiatric symptomatology should have a physical examination and blood work to test for thyroid disorders, anemia and other medical conditions. Also, it is not uncommon for pregnant women to stop psychotropic medication when they find out they are pregnant, so consider relapse or withdrawal symptoms.
Basic Psychiatric Assessment
A basic psychiatric evaluation helps to identify active symptoms that require treatment and measures the impact of symptoms on the patient’s functioning and safety. Follow these steps for a basic psychiatric assessment:
Review Current Psychiatric Symptoms.
Assess safety issues for the patient and the baby, including:
- suicidal or homicidal risks: If these are positive, the patient needs urgent attention and should go to an emergency room.
- manic and psychotic symptoms: If these are positive, the patient needs urgent psychiatric care and should go to an emergency room.
- significant substance use or misuse: The patient likely requires specific treatment to address active substance use problems and disorders concomitantly.
Review psychiatric history. If positive for bipolar disorder or a psychotic illness such as schizophrenia, the patient is at high risk of postpartum depression and psychosis, and should be followed by a psychiatrist.
Review the patient’s risk factors, including her support network.
Obtain collateral information about current symptoms and functioning from the patient’s partner or family members.
Learn more about bipolar disorder and mania and about psychosis.
Learn more about Assessment and Management of Suicide Risk.
Address sleep issues with all perinatal women because there is a very high correlation between sleep disturbances and mental health problems during pregnancy and the postpartum period. Evaluate the woman’s sleep patterns, including challenges with falling asleep, staying asleep and waking early.
Determine whether the sleep problems are due to physical constraints, such as belly size or frequent urination, or whether they are due to troubled thoughts or emotions. For a new mother, difficulty sleeping at night when her baby is asleep due to sadness, anxiety or agitation can be a sensitive marker of anxiety or depression.
Addressing the sleep problem can also address underlying perinatal mental health symptoms. Useful approaches include getting help with feedings and baby care during the night, implementing sleep hygiene strategies, taking part in psychotherapy (such as CBT) for insomnia and, in some instances, temporarily using medication to treat insomnia.