Clinical Challenges in Mental Health Presentations and Interventions during the Perinatal Period: A Cross-sectional, Retrospective Record-based Study in a Specialist Perinatal Clinic

Abstract Background: Presentations of perinatal psychiatric illnesses vary widely, and there are management concerns, particularly with medications, probably because of inadequate awareness and cautionary statements from licensing organizations. Aims: This study aimed to assess the clinical profile of psychiatric patients and the real-world interventions provided in a specialist perinatal clinic. Methods: Data from 30 antenatal and 30 postnatal consecutive patients attending perinatal psychiatry outpatient clinics covering two cities in the West Midlands, England, were collected from electronic case records. Results: The average age of the participants was 30.3 ± 5.2 years; the mean gestational duration was 6.5 ± 2.1 months, and the mean postnatal period was 6.5 ± 5.0 months. Mixed anxiety and depression (40.0%), emotionally unstable personality disorder (35.0%), and postnatal depression (20.0%) were more frequent diagnoses; comorbidity was present in 58.3%. Most (71.7%) of the patients were prescribed regular psychiatric medications, and 35% had “as required” medications; however, 25% had no regular or as-required medications. Antidepressants were given in 56.7%; most commonly sertraline and citalopram. Around a quarter (26.7%) of antenatal and half (46.7%) of postnatal patients received antipsychotic drugs, aripiprazole and quetiapine being the most commonly prescribed. Common as-required medications were promethazine, diazepam, and zopiclone. Verbal (78.3%) and written (35.0%) information about medications was provided, and 45% received psychological interventions. Conclusion: Most women with mental illness in the perinatal period were prescribed psychiatric drugs. Interventions can be improved through psychoeducation about medications, providing written information, and psychotherapeutic support.