6 General adult psychiatry6.2 Pregnancy, childbirth and the menstrual cycle
6.2.1 Assessing perinatal mental illness
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Timing and previous illness
Perinatal assessment covers pregnancy and the first year after birth. If the person already has a known illness, assessment starts before conception, with planning.
The history should cover previous episodes and how they responded to treatment, any medication changes, family history of severe perinatal illness and how things went after earlier births.
The risk of relapse after birth is particularly high in bipolar disorder. Assess promptly if the person needs less sleep, is becoming more and more active or has unusual beliefs.
How common perinatal illness is depends on the disorder and the time window studied. Do not let the rarer postpartum psychosis distract you from the common problems of depression and anxiety.
Anxiety and obsessive-compulsive symptoms
Presentation | Features to explore |
|---|---|
Generalised anxiety | Persistent worry and tension about many things, with difficulty controlling the worry |
Panic | Sudden episodes of fear with bodily symptoms, followed by avoidance or worry about further attacks |
Obsessive-compulsive disorder | Unwanted intrusive thoughts, with checking, avoidance, reassurance-seeking or mental rituals |
Birth-related PTSD (post-traumatic stress disorder) | Re-experiencing, avoidance and a sense of current threat linked to a traumatic birth |
Depression | Sustained low mood or loss of enjoyment, with poorer functioning and other symptoms |
Intrusive thoughts about harming the baby may be ego-dystonic obsessions, meaning they feel alien and unwanted. The person fears them, resists them and has no wish to act on them.
Psychotic beliefs or intent to harm need a different response. Do not judge risk from the content alone. Establish how firmly the belief is held, whether there is insight, what other symptoms are present, how the person is behaving and whether anyone is in immediate danger.
Avoidance and rituals can still disrupt feeding, bathing, sleep and contact with the baby, even when no harm is intended.
A complete assessment
Physical and obstetric review. Where indicated, consider thyroid disease, anaemia, infection, complications of the birth, medicines and substance use.
Social history. Ask about support, housing, money, domestic abuse and what the pregnancy means to the person. Ask about abuse when they are alone.
Screening tools. These help pick up possible illness and track symptoms, but a score does not replace a diagnostic interview or a risk assessment.
Function. Ask about self-care, eating, sleep, care of the baby, relationships and whether the person can get to appointments.
A shared plan. Agree a plan that sets out treatment, specialist perinatal input when needed, warning signs, monitoring and who to contact urgently.