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Perinatal Mixed Affective State: Wherefore Art Thou?

Alexia Emilia Koukopoulos1, Gloria Angeletti2, Gabriele Sani3

  • 1SPDC, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza School of Medicine and Dentistry, Rome, Italy; Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy.

The Psychiatric Clinics of North America
|February 4, 2020
PubMed
Summary

Mixed states during perinatal mood episodes are often missed due to assessment tool limitations. Identifying these mixed features in postpartum depression is crucial to avoid misdiagnosis, especially in bipolar disorder contexts.

Keywords:
Bipolar disorderMixed affective stateMixed depressionPerinatal periodPeripartumPostpartumPregnancyWomen

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Area of Science:

  • Perinatal mental health
  • Psychiatry
  • Mood disorders

Background:

  • Mixed states in perinatal mood episodes are infrequently reported.
  • Inadequate assessment tools may contribute to underdiagnosis.
  • Perinatal mood disorders require accurate identification for effective treatment.

Purpose of the Study:

  • To review and quantify the occurrence of mixed symptoms in women experiencing perinatal mood episodes.
  • To investigate the identifiability of mixed states within reported cases of postpartum depression.
  • To assess the diagnostic implications of applying the DSM-5 mixed features specifier.

Main Methods:

  • Selective literature review of studies reporting mixed symptoms in the perinatal period.
  • Analysis of reported cases of postpartum depression for evidence of mixed features.
  • Evaluation of diagnostic criteria, specifically the DSM-5 mixed features specifier.

Main Results:

  • Mixed states were identifiable in numerous reported instances of postpartum depression.
  • Mixed features were noted in both first-onset and bipolar disorder-related postpartum episodes.
  • Strict application of the DSM-5 mixed features specifier may lead to misdiagnosis.

Conclusions:

  • Mixed states are more common in perinatal mood episodes than previously thought.
  • Improved assessment tools are needed for accurate identification of perinatal mixed states.
  • Careful application of diagnostic criteria is essential to prevent misdiagnosis of postpartum depression and related disorders.