Top

Published in:

01-06-2010 | Review Article

Screening for bipolar disorder during pregnancy and the postpartum period

Authors: Cheryl Ann Chessick, Sona Dimidjian

Published in: Archives of Women's Mental Health | Issue 3/2010

Abstract

Bipolar disorder is a significant mental health problem among perinatal women; however, little attention has been devoted to methods of screening for bipolar disorder during this phase of women’s life cycle. There is a need for reliable and valid screening instruments for perinatal women. This paper presents a review of 11 self-report measures used to screen bipolar disorder in the general population and discusses their applicability to screening among perinatal women. Published psychometric data, including reliability, sensitivity, specificity, and positive predictive value of each self-report instrument, is presented and critiqued. We make recommendations for screening in clinical practice and highlights priorities for future research. The need for more research in this area is emphasized.

Akiskal HS (1996) The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 16(2 Suppl 1):4S–14SCrossRefPubMed

Akiskal HS, Benazzi F (2005) Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II? J Affect Disord 84(2–3):209–217CrossRefPubMed

Akiskal HS, Walker P, Puzantian VR, King D, Rosenthal TL, Dranon M (1983) Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. J Affect Disord 5(2):115–128CrossRefPubMed

Akiskal HS, Bourgeois ML, Angst J, Post R, Moller H, Hirschfeld R (2000) Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 59(Suppl 1):S5–S30CrossRefPubMed

Altman EG, Hedeker D, Peterson JL, Davis JM (1997) The Altman Self-Rating Mania Scale. Biol Psychiatry 15;42(10):948–955CrossRef

Altman E, Hedeker D, Peterson JL, Davis JM (2001) A comparative evaluation of three self-rating scales for acute mania. Biol Psychiatry 15;50(6):468–471CrossRef

American Psychiatric Association (2000) In: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision ed. American Psychiatric Association, Washington, DC

American Psychiatric Association (2002) Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 159:1–50CrossRef

Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD et al (2005) The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 88(2):217–233CrossRefPubMed

Bauer MS, Crits-Christoph P, Ball WA, Dewees E, McAllister T, Alahi P et al (1991) Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania. Arch Gen Psychiatr 48(9):807–812PubMed

Bauer MS, Vojta C, Kinosian B, Altshuler L, Glick H (2000) The Internal State Scale: replication of its discriminating abilities in a multisite, public sector sample. Bipolar Disord 2(4):340–346CrossRefPubMed

Blacker D, Endicott J (2000) Psychometric properties. In: Rush A, First M, Blacker D (eds) Handbook of Psychiatric Measures. American Psychiatric Association, Washington DC, pp 7–14

Boudreaux ED, Cagande C, Kilgannon JH, Clark S, Camargo CA (2006) Bipolar disorder screening among adult patients in an urban emergency department setting. Prim Care Companion J Clin Psychiatry 8(6):348–351CrossRefPubMed

Boyd RC, Le HN, Somberg R (2005) Review of screening instruments for postpartum depression. Arch Womens Ment Health 8(3):141–153CrossRefPubMed

Brand SR, Brennan MA, Brennan PA (2009) Impact of antenatal and postpartum maternal mental illness: how are the children? Clin Obstet Gynecol 52(3):441–455CrossRefPubMed

Braunig P, Shugar G, Kruger S (1996) An investigation of the Self-Report Manic Inventory as a diagnostic and severity scale for mania. Compr Psychiatr 37(1):52–55CrossRef

Brockington I (1996) Motherhood and mental health. Oxford University Press, Oxford, pp 200–284

Brown ES, Bauer MS, Suppes T, Khan DA, Carmody T (2000) Comparison of the internal state scale to clinician-administered scales in asthma patients receiving corticosteroid therapy. Gen Hosp Psychiatr 22(3):180–183CrossRef

Buist AE, Barnett BE, Milgrom J, Pope S, Condon JT, Ellwood DA et al (2002) To screen or not to screen—that is the question in perinatal depression. Med J Aust 177(Suppl):S101–S105PubMed

Burt VK, Rasgon N (2004) Special considerations in treating bipolar disorder in women. Bipolar Disord 6:2–13CrossRefPubMed

Carta MG, Hardoy MC, Cadeddu M, Murru A, Campus A, Morosini PL et al (2006) The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample. Clin Pract Epidemiol Ment Health 2:2CrossRefPubMed

Cohen LS (2007) Treatment of bipolar disorder during pregnancy. J Clin Psychiatr 68(Suppl 9):4–9

Cooke RG, Kruger S, Shugar G (1996) Comparative evaluation of two self-report Mania Rating Scales. Biol Psychiatr 40(4):279–283CrossRef

Coryell W, Scheftner W, Keler M, Endicott J, Maser J, Klerman GL (1993) The enduring psychosocial consequences of mania and depression. Am J Psychiatr 150(5):720–727PubMed

de Dios C, Ezquiaga E, Garcia A, Montes JM, Avedillo C, Soler B (2008) Usefulness of the Spanish version of the Mood Disorder Questionnaire for screening bipolar disorder in routine clinical practice in outpatients with major depression. Clin Pract Epidemiol Ment Health 4:14CrossRefPubMed

Depue RA, Klein DN (1988) Identification of unipolar and bipolar affective conditions in nonclinical and clinical populations by the general behavior inventory. In: Dunner DL, Gershon ES, Barrett JE (eds) Relatives at Risk for Mental Disordes. Raven, New York, pp 179–204

Depue RA, Slater JF, Wolfstetter-Kausch H, Klein D, Goplerud E, Farr D (1981) A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: a conceptual framework and five validation studies. J Abnorm Psychol 90(5):381–437CrossRefPubMed

Depue RA, Krauss S, Spoont MR, Arbisi P (1989) General behavior inventory identification of unipolar and bipolar affective conditions in a nonclinical university population. J Abnorm Psychol 98(2):117–126CrossRefPubMed

Dew MA, Switzer GE, Myaskovsky L, DiMartini AF, Tovt-Korshynska MI (2006) Rating scales for mood disorders. In: Stein DJ, Kupfer DJ, Schatzberg AF (eds) The American Psychiatric Publishing Textbook of Mood Disorders. American Psychiatric Publishing, Arlington, pp 69–97

Eckblad M, Chapman LJ (1986) Development and validation of a scale for hypomanic personality. J Abnorm Psychol 95(3):214–222CrossRefPubMed

Endicott J, Spitzer RL (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatr 35(7):837–844PubMed

First MB, Spitzer RL, Gibbon M, Williams JBW (1994) Structured clinical interview for axis I DSM-IV disorders, patient edition. SCID-I/P, Version 2.0. New York State Psychiatric Institute, Biometrics Research, New York

Freeman MD, Gelenberg A (2005) Bipolar disorder in women: reproductive events and treatment considerations. Acta Psychiatr Scand 112:88–96CrossRefPubMed

Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R et al (2002) The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatr 63(4):284–287

Frye MA, Salloum IM (2006) Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord 8(6):677–685CrossRefPubMed

Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 119:1–8

Gentile S (2006) Prophylactic treatment of bipolar disorder in pregnancy and breastfeeding: focus on emergin mood stabilizers. Bipolar Disord 8:207–220CrossRefPubMed

Ghaemi SN, Sachs GS, Chiou AM, Pandurangi AK, Goodwin K (1999) Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord 52(1–3):135–144CrossRefPubMed

Ghaemi SN, Boiman E, Goodwin FK (2000) Insight and outcome in bipolar, unipolar, and anxiety disorders. Compr Psychiatr 41(3):167–171CrossRef

Ghaemi SN, Hsu DJ, Ko JY, Baldassano CF, Kontos NJ, Goodwin FK (2004) Bipolar spectrum disorder: a pilot study. Psychopathology 37(5):222–226CrossRefPubMed

Glick HA, McBride L, Bauer MS (2000) A manic-depressive symptom self-report in optical scanable format. Bipolar Disord 5(5):366–369CrossRef

Glover V, Liddle P, Taylor A, Adams D, Sandler M (1994) Mild hypomania (the highs) can be a feature of the first postpartum week. Association with later depression. Br J Psychiatr 164(4):517–521CrossRef

Goldberg JF, Ernst CL (2002) Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. J Clin Psychiatr 63(11):985–991

Goodwin FK, Jamison KR (2007) Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd edn. Oxford University Press, New York

Hardoy MC, Cadeddu M, Murru A, Dell'Osso B, Carpiniello B, Morosini PL et al (2005) Validation of the Italian version of the "Mood Disorder Questionnaire" for the screening of bipolar disorders. Clin Pract Epidemiol Ment Health 21:1–8

Harvey AG (2008) Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. Am J Psychiatr 165(7):820–829CrossRefPubMed

Hasegawa M (2000) Mild hypomania phenomenon in Japanese puerperal women. Nurs Health Sci 2:231–235CrossRef

Heron J, Haque S, Oyebode F, Craddock N, Jones I (2009) A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period. Bipolar Disord 11:410–417CrossRefPubMed

Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr et al (2000) Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatr 157(11):1873–1875CrossRefPubMed

Hirschfeld RM, Calabrese JR, Weissman MM, Reed M, Davies MA, Frye MA et al (2003) Screening for bipolar disorder in the community. J Clin Psychiatr 64(1):53–59CrossRef

Hirschfeld RM, Cass AR, Holt DC, Carlson CA (2005) Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Fam Pract 18(4):233–239CrossRefPubMed

Huang CL, Yang YK, Chen M, Lee IH, Yeh TL, Yang MJ (2003) Patient- and family-rated scale for bipolar disorder symptoms: Internal State Scale. Kaohsiung J Med Sci 19(4):170–176CrossRefPubMed

Isometsa E, Suominen K, Mantere O, Valtonen H, Leppamaki S, Pippingskold M et al (2003) The Mood Disorder Questionnaire improves recognition of bipolar disorder in psychiatric care. BMC Psychiatr 10:3–8

Jones I, Craddock N (2001) Familiality of the puerperal trigger in bipolar disorder: results of family study. Am J Psychiatr 158:913–917PubMed

Judd LL, Akiskal HS (2003) The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 73(1–2):123–131CrossRefPubMed

Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA et al (2002) The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatr 59(6):530–537CrossRefPubMed

Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD et al (2003) A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatr 60(3):261–269CrossRefPubMed

Kemp DE, Hirschfeld RM, Ganocy SJ, Elhaj O, Slembarski R, Bilali S et al (2008) Screening for bipolar disorder in a county jail at the time of criminal arrest. J Psychiatr Res 42(9):778–786CrossRefPubMed

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatr 62(6):617–627CrossRefPubMed

Kinsella MT, Monk C (2009) Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol 52(3):425–440CrossRefPubMed

Klein DN, Depue RA (1984) Continued impairment in persons at risk for bipolar affective disorder: results of a 19-month follow-up study. J Abnorm Psychol 93(3):345–347CrossRefPubMed

Konuk N, Kiran S, Tamam L, Karaahmet E, Aydin H, Atik L (2007) Validation of the Turkish version of the Mood Disorder Questionnaire for screening bipolar disorders. Turk Psikiyatri Derg 18(2):147–154PubMed

Kwapil TR, Miller MB, Zinser MC, Chapman LJ, Chapman J, Eckblad M (2000) A longitudinal study of high scorers on the hypomanic personality scale. J Abnorm Psychol 109(2):222–226CrossRefPubMed

Lane A, Keville R, Morris M, Kinsella A, Turner M, Barry S (1997) Postnatal depression and elation among mothers and their partners: prevalence and predictors. Br J Psychiatr 171:550–555CrossRef

Mallikarjun PK, Oyebode F (2005) Prevention of postnatal depression. J R Soc Promot Health 125(5):221–226CrossRefPubMed

Meyer TD, Hammelstein P, Nilsson LG, Skeppar P, Adolfsson R, Angst J (2007) The Hypomania Checklist (HCL-32): its factorial structure and association to indices of impairment in German and Swedish nonclinical samples. Compr Psychiatr 48(1):79–87CrossRef

Miklowitz DJ, Johnson SL (2006) The psychopathology and treatment of bipolar disorder. Annu Rev Clin Psychol 2:199–235CrossRefPubMed

Miller CJ, Klugman J, Berv DA, Rosenquist KJ, Ghaemi SN (2004) Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. J Affect Disord 81(2):167–171CrossRefPubMed

Miller L, Shade M, Vasireddy V (2009) Beyond screening: assessment of perinatal depression in a perinatal care setting. Arch Womens Ment Health 12(5):329–334 doi:10.1007/s00737-009-0082-5

Munk-Olsen T, Munk Larsen T, Bocker Pedersen C (2006) New parents and mental disorders: a population-based registry study. JAMA 296(21):2582–2589CrossRefPubMed

Nassir Ghaemi S, Miller CJ, Berv DA, Klugman J, Rosenquist KJ, Pies RW (2005) Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J Affect Disord 84(2–3):273–277CrossRefPubMed

Parker G, Hadzi-Pavlovic D, Tully L (2006) Distinguishing bipolar and unipolar disorders: an isomer model. J Affect Disord 96(1–2):67–73CrossRefPubMed

Parker G, Fletcher K, Barrett M, Synnott H, Breakspear M, Hyett M et al (2008) Screening for bipolar disorder: the utility and comparative properties of the MSS and MDQ measures. J Affect Disord 109(1–2):83–89CrossRefPubMed

Payne JL, MacKinnon DF, Mondimore FM, McInnis MG, Schweizer B, Zamoiski RB et al (2008) Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees. Bipolar Disord 10(1):38–44PubMed

Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR et al (2006) Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatr 163(2):217–224CrossRefPubMed

Phelps JR, Ghaemi SN (2006) Improving the diagnosis of bipolar disorder: predictive value of screening tests. J Affect Disord 92(2–3):141–148CrossRefPubMed

Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD et al (2002) Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 21;136(10):765–776

Sanchez-Moreno J, Villagran JM, Gutierrez JR, Camacho M, Ocio S, Palao D et al (2008) Adaptation and validation of the Spanish version of the Mood Disorder Questionnaire for the detection of bipolar disorder. Bipolar Disord 10(3):400–412CrossRefPubMed

Schneck CD, Miklowitz DJ, Calabrese JR, Allen MH, Thomas MR, Wisniewski SR et al (2004) Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the Systematic Treatment Enhancement Program. Am J Psychiatr 161(10):1902–1908CrossRefPubMed

Schneck CD, Miklowitz DJ, Miyahara S, Araga M, Wisniewski S, Gyulai L et al (2008) The prospective course of rapid-cycling bipolar disorder: findings from the STEP-BD. Am J Psychiatr 165(3):370–377, quiz 410CrossRefPubMed

Shabani A, Koohi-Habibi L, Nojomi M, Chimeh N, Ghaemi SN, Soleimani N (2009) The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire in screening the patients with bipolar disorder. Arch Iran Med 12(1):41–47PubMed

Sharma V (2008) Management of bipolar II disorder during pregnancy and the postpartum period—Motherisk Update 2008. Can J Clin Pharmacol 16(1):e33–e41

Sharma V (2009) Management of bipolar II disorder during pregnancy and the postpartum period. Can J Clin Pharmacol 16(1):e33–e41PubMed

Sharma V, Khan M, Corpse C, Sharma P (2008) Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disord 10(6):742–747CrossRefPubMed

Shugar G, Schertzer S, Toner BB, Di Gasbarro I (1992) Development, use, and factor analysis of a self-report inventory for mania. Compr Psychiatr 33(5):325–331CrossRef

Smith S, Heron J, Haque S, Clarke P, Oyebode F, Jones I (2009) Measuring hypomania in the postpartum: a comparison of the Highs Scale and the Altman Mania Rating Scale. Arch Womens Ment Health 12:323–327CrossRefPubMed

Solomon DA, Leon AC, Maser JD, Truman CJ, Coryell W, Endicott J et al (2006) Distinguishing bipolar major depression from unipolar major depression with the screening assessment of depression-polarity (SAD-P). J Clin Psychiatr 67(3):434–442CrossRef

Spinelli MG (2009) Postpartum psychosis: detection of risk and management. Am J Psychiatr 166(4):405–408CrossRefPubMed

Stang P, Frank C, Ulcickas Yood M, Wells K, Burch S (2007) Impact of bipolar disorder: results from a screening study. Prim Care Companion J Clin Psychiatr 9(1):42–47CrossRef

Tafalla M, Sanchez-Moreno J, Diez T, Vieta E (2009) Screening for bipolar disorder in a Spanish sample of outpatients with current major depressive episode. J Affect Disord 114(1–3):299–304CrossRefPubMed

Twiss J, Jones S, Anderson I (2008) Validation of the Mood Disorder Questionnaire for screening for bipolar disorder in a UK sample. J Affect Disord 110(1–2):180–184CrossRefPubMed

Vieta E, Sanchez-Moreno J, Bulbena A, Chamorro L, Ramos JL, Artal J et al (2007) Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Spanish: the 32 item hypomania symptom check list (HCL-32). J Affect Disord 101(1–3):43–55CrossRefPubMed

Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ (2000) Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatr 157:179–184CrossRefPubMed

Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A et al (2007) Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatr 164(12):1817–1824, quiz 923CrossRefPubMed

Weber Rouget B, Gervasoni N, Dubuis V, Gex-Fabry M, Bondolfi G, Aubry JM (2005) Screening for bipolar disorders using a French version of the Mood Disorder Questionnaire (MDQ). J Affect Disord 88(1):103–108CrossRefPubMed

Webster J, Pritchard MA, Creedy D, East C (2003) A simplified predictive index for the detection of women at risk for postnatal depression. Birth 30(2):101–108CrossRefPubMed

Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L et al (2004) Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatr 161(4):608–620CrossRefPubMed

Title: Screening for bipolar disorder during pregnancy and the postpartum period
Authors: Cheryl Ann Chessick
Sona Dimidjian
Publication date: 01-06-2010
Publisher: Springer Vienna
Published in: Archives of Women's Mental Health / Issue 3/2010
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-010-0151-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Screening for bipolar disorder during pregnancy and the postpartum period

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2010

Risk behaviors for HCV- and HIV-seroprevalence among female crack users in Porto Alegre, Brazil

Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy

Erratum to: Reliability and validity of the Dutch version of the Maternal Antenatal Attachment Scale

Validation of the Edinburgh Postnatal Depression Scale among women in a high HIV prevalence area in urban Zimbabwe

“Under My Umbrella”: The housing experiences of HIV positive parents who live with and care for their children in Ontario

Reliability and validity of the Dutch version of the maternal antenatal attachment scale