As a follow-up to our post on postpartum depression and bipolar illness we are urging all clinicians to incorporate a screen for both symptoms of bipolar illness and psychosis when assessing all postpartum women. At the PPSC, we use the Mood Disorder Questionnaire (MDQ) (don’t forget to cite the authors if you opt to copy it.) For psychosis, we use screening questions that are consistent with DSM-IV-TR criteria. You may want to develop your own list of questions, at the PPSC we have come up with the following:
Ask her, and those who are with her, the following questions:
- Does she or anyone in her family have a history of bipolar illness or previous psychosis?
- Is she talking or acting in a strange manner that is not characteristic for her?
- Is she unusually quiet and withdrawn, or speaking rapidly with little concentration?
- Does she claim to hear things or see things that others do not?
- Is she suspicious of others or expressing concern that others are out to get her or trying to harm her in some way?
- Does she have a decreased need for sleep or food and/or exhibit a high degree of confidence or an exaggerated sense of her capabilities or self-worth?
- Does she feel abnormally hyperactive with racing thoughts and/or behaviors?
You may want to make the Mood Questionnaire and psychosis screening questions a regular part of your assessment forms or you might decide you are more comfortable including these questions as a part of your first clinical session. Either way, these are difficult questions to ask, but important nonetheless.