Mood, anxiety and obsessive compulsive disorders in pregnancy and the postpartum period

Abstract

Introduction Mental illness in pregnancy and postpartum has significant and potentially serious long-term consequences for a mother, her entire family, and in particular, for her infant (Grigoriadis, VonderPorten et al. 2013c). Perinatal mood and anxiety disorders are not culturally bound: they affect women in every society and from every socioeconomic background. The aim of this chapter is to increase awareness among healthcare providers about mood- and anxiety-related disorders in pregnancy and postpartum (the “perinatal” period). To achieve this goal, the chapter provides key information about the presentation of these disorders in the perinatal period, along with research about biological and psychosocial risk factors for illness. Clinical presentations Most psychiatric disorders can occur in the perinatal period, but mood and anxiety disorders are particularly common among women of reproductive age. Pregnancy is not protective against the development or recurrence of these disorders, and evidence suggests that the postpartum period is a time of increased risk for new-onset mood and anxiety problems. In particular, there is a risk of mood-related psychosis in the postpartum period, with women suffering from bipolar disorder at high risk. Further, there is a high risk of comorbidity with mood and anxiety disorders co-occurring (Grigoriadis, et al. 2011). In the 5th edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) mood and anxiety disorders are classified into five separate categories: Depressive disorders, Bipolar and related disorders, Anxiety disorders (including generalized anxiety disorder, panic disorder and social anxiety disorder), Obsessive-compulsive and related disorders, and Trauma and Stressor-related disorders (including adjustment disorder, acute stress disorder and post-traumatic stress disorder [PTSD]) (American Psychiatric Association, 2013). Mood and anxiety disorders occurring in pregnancy or postpartum are not classified as distinct disorders in the DSM-5. However, due to the distinct risks related to perinatal mood disorders, episodes of depressive and bipolar disorders occurring during this time are classified with the use of the specifier: “with peripartum onset.” Specifically, the DSM-5 specifier indicates that “peripartum-onset” pertains only to episodes occurring in pregnancy or with onset in the first four weeks after delivery, although research suggests that risk is likely elevated throughout the first postpartum year.