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Appropriate responses to assessments

The following is a useful guide for appropriate responses to assessments, identifying treatments, actions and providers of support/treatment services for women experiencing perinatal depression, anxiety, bipolar disorder and puerperal psychosis.

 

TreatmentActionsWho
Risk or symptoms of mental health disorder
Psycho-educationDiscuss mental health and give relevant emotional health booklet.
Community supportGive details of support groups, early parenting centres etc.Primary or community care professional.
Lifestyle adviceProvide advice on sleep, relaxation and physical activity.
Previous history of mental health disorder including mild to moderate symptoms of depression/anxiety in the perinatal period
Psychosocial supportAssist with accessing support (e.g. family, peer support).
Monitoring and reviewConsider possible puerperal psychosis/bipolar disorder and referral to psychiatrist.Primary or community care professional.
Arrange monitoring if symptoms escalate.
Mild to moderate depression
Psychosocial supportProvide information on self-help strategies.
Non-directive counsellingTake an empathetic and woman-centred approach.Primary or community care, mental health nurse, psychologist, psychiatrist.
Psychological therapyConsider CBT, IPT or psychodynamic therapy.
MedicationConsider in combination with psychological therapy.
Mother-infant psychotherapyRefer to perinatal and infant mental health specialist if there are difficulties with mother-infant interaction.
Severe depression
MedicationConsider as a first step and in combination with psychological therapy.
Psychological therapyConsider CBT and IPT based on the individual's ability to engage in psychological therapy.Psychiatrist, psychologist, perinatal/infant mental health specialist.
Mother-infant psychotherapyRefer to perinatal and infant mental health specialist if there are difficulties with mother-infant interaction.
Anxiety disorder
Psychological treatmentMild-moderate - consider CBT or IPT and self-help strategies.
Medication (see Table 1)Moderate-severe - consider medication including short-term use of benzodiazepines while awaiting onset of action of SSRI.Primary or community care, psychologist, mental health nurse, psychiatrist.
Mother-infant psychotherapyRefer to perinatal and infant mental health specialist if there are difficulties with mother-infant interaction.
Bipolar disorder/puerperal psychosis
ReferralRefer for urgent specialist mental health assessment and inpatient admission.
Medication (see Table 1)Prescribe medication.Psychiatrist, psychologist, inpatient care probable.
Psychological therapyConsider individual or mother-infant therapy as woman recovers.

At all times when mental health problems are identified, consider the potential impact on the mother and infant interaction.

Note: CBT= Cognitive Behaviour Therapy; IPT=Interpersonal Psychotherapy