Screening mixed depression and bipolarity in the postpartum period at a primary health care center

Çelik, Sercan Bulut; Bucaktepe, Gamze Erten; Uludağ, Ayşegül; Bulut, İbrahim Umud; Erdem, Özgür; Altınbaş, Kürşat

doi:10.1016/j.comppsych.2016.07.013

Cited by 15 publications

(6 citation statements)

References 32 publications

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“…154 Mixed symptoms appear to be particularly common after childbirth and may be more common during this period than at other times in a woman's life. Celik et al reported that nearly 69% had at least five symptoms of mania as measured by the Modified Hypomania Checklist (mHCL-32), 155 which has shown to be a useful tool for detecting symptoms of mixed depression. 156 Viguera et al studied more than 1000 women and found that 6.5% of those with BDI and 2.5% of those with BDII had mixed episodes in the postpartum period.…”

Section: Peripartummentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations

et al. 2021

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Objectives: The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendations were not provided-a critical gap which the current update aims to address. Method: Overview of research regarding mixed presentations in BD, with treatment recommendations developed using a modified CANMAT/ISBD rating methodology. Limitations are discussed, including the dearth of high-quality data and reliance on expert opinion. Results: No agents met threshold for first-line treatment of DSM-5 manic or depressive episodes with mixed features. For mania + mixed features second-line treatment options include asenapine, cariprazine, divalproex, and aripiprazole. In depression + mixed features, cariprazine and lurasidone are recommended as second-line options. For DSM-IV defined mixed episodes, with a longer history of research, asenapine and aripiprazole are first-line, and olanzapine (monotherapy or combination), carbamazepine, and divalproex are second-line. Research on maintenance treatments following a DSM-5 mixed presentation is extremely limited, with third-line recommendations based on expert opinion. For maintenance treatment following a DSM-IV mixed episode, quetiapine (monotherapy or combination) is first-line, and lithium and olanzapine identified as second-line options. Conclusion: The CANMAT and ISBD groups hope these guidelines provide valuable support for clinicians providing care to patients experiencing mixed presentations, as well as further influence investment in research to improve diagnosis and treatment of this common and complex clinical state. K E Y W O R D S bipolar disorder, guidelines, mixed features, pharmacotherapy TA B L E 1 Characteristics of bipolar disorder with mixed presentations Earlier age of onset Increased risk for hospitalization Higher rates of medical and psychiatric comorbidities Poorer treatment response More frequent and severe episodes (less time euthymic) Poorer response to maintenance treatments Higher risk for suicidal behavior

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Section: Peripartummentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations

et al. 2021

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“…This screening tool has shown to be useful in identifying women at high risk of bipolar disorder or mixed depression when used in the primary care setting. 26 A diagnosis of MDD with mixed features should be considered in cases where both the EPDS and MDQ are positive but psychiatric assessment does not identify a bipolar disorder. The diagnostic algorithm presented in Figure 1 shows a potential pathway that can be followed in the screening and diagnosis of postpartum mood disorders.…”

Section: Principles Of Identifying Peripartum Mood Disordersmentioning

confidence: 99%

“…A positive MDQ indicates a possible bipolar spectrum disorder requiring further evaluation through psychiatric assessment. This screening tool has shown to be useful in identifying women at high risk of bipolar disorder or mixed depression when used in the primary care setting 26 . A diagnosis of MDD with mixed features should be considered in cases where both the EPDS and MDQ are positive but psychiatric assessment does not identify a bipolar disorder.…”

Section: Principles Of Identifying Peripartum Mood Disordersmentioning

confidence: 99%

Between a rock-a-bye and a hard place: mood disorders during the peripartum period

Thomson

Sharma

2017

CNS Spectr.

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Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential for devastating outcomes including suicide and infanticide. Women are routinely screened for unipolar depression during or after pregnancy but not for bipolar disorder, in spite of the fact that childbirth is associated with a major risk for onset or exacerbation of bipolar disorder. Delays in detection as well as misdiagnosis of bipolar disorder as major depressive disorder may put women at risk of many adverse consequences, including symptom exacerbation, psychiatric hospitalization, and suicide. A thorough psychiatric assessment is necessary to establish diagnosis, to address safety issues, and to formulate a treatment plan. Treatment of mood disorders during pregnancy is complicated by the potential risks of fetal exposure to psychotropic medications, and the use of these medications during the postpartum period may result in infant medication exposure through breastmilk. These risks of psychotropic medication exposure must be weighed against the risk of untreated mood disorders. This review will discuss the pathophysiology, epidemiology, diagnosis, and treatment of mood disorders during pregnancy and the postpartum period. Screening tools that can be used in the primary care and obstetrics settings to assist in identifying women with peripartum mood disorders will also be discussed.

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“…Prompt MxD diagnosis during this period favorably impacts treatment and prevents possible negative consequences on the offspring's future development (Rusner et al, 2016). Hence, a specific diagnostic tool could prove helpful in clinical practice (Çelik et al, 2016;A.E. Koukopoulos et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The Koukopoulos mixed depression rating scale (KMDRS) and the assessment of mixed symptoms during the perinatal period

Koukopoulos

Chiara²,

Simonetti

et al. 2021

Journal of Affective Disorders

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Screening mixed depression and bipolarity in the postpartum period at a primary health care center

Cited by 15 publications

References 32 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations

Between a rock-a-bye and a hard place: mood disorders during the peripartum period

The Koukopoulos mixed depression rating scale (KMDRS) and the assessment of mixed symptoms during the perinatal period

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