Peripartum mood disturbances diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunita Kumawat, M.B.B.S[2]

Overview

Diagnostic studies have resulted in significant increases in the identification of postpartum mental problems . To rule out an organic cause, laboratory tests and a complete physical examination should be performed. Rare medical diseases such as frontotemporal dementia, Sheehan syndrome, or frontal lobe tuberculoma, can sometimes present as peripartum mood disturbances. Blood test and other tests are ordered to rule out any organic cause of peripartum mood disturbances. Then the physician asks a set of questions to diagnose the specific mood disorder.

Diagnostic Study of Choice

A complete blood count, electrolytes, BUN, creatinine, folate, glucose,  thyroid function tests,Vitamin B12, calcium, urinalysis, and urine culture in a fever patient; and a urine drug screen are some important laboratory tests. The diagnosis of Postpartum depression is made when at least 5 of the following mentioned diagnostic criteria are met:

• Changes in sleep pattern,
  
• Feelings of hopelessness or sadness,
  
• Feelings of restlessness,
  
• Loss of interest in activities,
  
• Feelings of guilt,
  
• Loss of energy,
  
• Loss of concentration,
  
• Change in appetite or weight,
  
• Thoughts of death or suicide.

Patients with postpartum psychosis are diagnosed under the DSM-5, based on their primary mental illness with the addition of the "peripartum onset" if it presents during pregnancy or within four weeks after delivery.

The diagnosis of postpartum blues is made if three or four of depressive symptoms are present. The postpartum blues is defined by International Classification of Diseases – 10th Revision (ICD-10) as postpartum depression not otherwise specified.