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PSI Perinatal Mental Health Certification
Exam
Theories of etiology - ANS biological sensitivities to hormone changes (sleep), genetic vulnerability (prior diagnosis), psychological (identity), social/environmental (poor social support/racism) Baby Blues - ANS Affects 60-80% new mothers. Due to hormone changes and sleep deprivation. lasts 2 days to 2 weeks. Tearful, labile affect, reactivity, exhaustion BUT predominately happy, self-esteem remains unchanged. Resolves without intervention. Recommend self care strategies. How to determine is it blues or depression - ANS severity, intensity, duration of symptoms Prevalence of postpartum anxiety - ANS 8-20% Prevalence of prenatal anxiety - ANS 15% Prevalence of postpartum depression - ANS 21% Prevalence of postpartum panic disorder - ANS 11% Prevalence of postpartum OCD - ANS 11% Prevalence of postpartum PTSD - ANS 9% Percentage of bipolar symptoms that relapse w/o meds - ANS 70% Prevalence of postpartum psychosis - ANS 1-2 out of 1,
Prevalence of PPD in fathers - ANS 10% Prevalence psychosis in women with known bipolar disorder - ANS 20-30% Traits of OCD - ANS recognizes that thoughts are unhealthy, extreme anxiety related to thoughts/images, concerned about "snapping". parent does not want to harm the baby, thoughts are frightening. Traits of psychosis - ANS does not recognize actions/thoughts are unhealthy, may seem to have less anxiety when indulging in thoughts/behaviors, no insight about distortion of thoughts, parent has delusional beliefs about the baby, thoughts of harming the baby are ego-syntonic Traits of PTSD - ANS intrusive thoughts (flashbacks), avoidance, negative cognitions and mood, arousal (sleep disturbance, poor concentration, aggression, hyper vigilance) maternal mortality-all women - ANS 1,200 a year or 14.4 per 100, maternal mortality-black women - ANS 43.5 per 100, Bipolar 1 Disorder - ANS a type of bipolar disorder marked by at least one lifetime full manic and major depressive episodes Hypomania - ANS A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless. up to 4 days in length mania - ANS a mood disorder marked by a hyperactive, wildly optimistic state-function is impaired. can last 7 days
Alcohol use in pregnancy - ANS 8.5% of women drank within last month, most during first trimester (17.9%) Postpartum substance abuse - ANS 40-49% report alcohol use, 4.5-8.5% report marijuana use Risks for single parents - ANS twice as likely to report depressive and anxious symptoms over partnered parents. NICU rates - ANS 10-15% of babies spend time in the NICU NICU parents often traumatized high rate of anxiety and depression Maternal psychological impact of neonate - ANS parents: difficulty bonding, poor attunement, smile less, less eye contact, avoid physical contact, less verbalization the depressive dyad - ANS when mom is depressed, babies are more often: delayed in speech and cog development, short attention span, sleep problems, feeding issues, increased frequency of GI upset, prone to colic, excessive crying, irritability. NICU family prevalence of PMADS - ANS 20-30% of diagnosable mental health disorder. more experience PTSD NICU moms rate of depression - ANS up to 63% NICU moms rate of anxiety - ANS up to 27% NICU moms rate of PTSD - ANS 53%
NICU dads - ANS 30% screen positive for depressive symptoms Risk of PTSD in NICU - ANS related to parent's baseline coping and not size/sickness of baby Moms who lost a pregnancy increased risk for - ANS PTSD, OCD, anxiety Timing of pregnancy losses - ANS 80% first three months, 14% second tri, 6% third tri Neonatal mortality rate - ANS 3.9 per 1,000 births congenital abnormalities account for 20% of deaths leading causes of infant death - ANS congenital abnormalities, preterm/low birth weight, SIDS, maternal pregnancy complications, injuries Infertility Stats - ANS 1 in 8 couples 1/3 each maternal/paternal/unknown problem Multiplies stats - ANS 33.3 of 1000 births are twins, parents experience heightened symptoms of depression, anxiety and parenting stress PADS - ANS post adoption depression syndrome. can affect all adoptive mothers, but higher in adoption of older children and those coming from institutions. American Academy of Pediatrics on breastfeeding - ANS infants should be exclusively breast fed for first 6 months of life. Then add food. Breastfeeding should continue for at least the first year of life
medical risks for teenage mothers - ANS high blood pressure anemia, nutritional deficiencies, early labor, preterm labor, low birth weight, STDs, higher rate of infant mortality, obstructed labor predictive factors for PMADS in adolescent mothers - ANS untreated depression in their mothers, social isolation/peer rejection, weight/shape disturbance, low maternal self-efficacy, family conflict, low self- esteem Teens and PMADS - ANS almost 1/2 reported depressive symptoms, can last up to 4 years after birth. decreased quality of life, interference with developmental tasks of adolescence, stressed relationship with parents, friends and family, decreased maternal role functioning, disrupts school and work pl ANS. most go untreated. Military PMAD risk - ANS deployment of spouse during entire pregancy associated with 3.4%increase in preterm delivery and 3 %increased risk for PPD 66% military spouses reported that seeking mental health support would hurt spouse's chance of promotion PSI Recommendations for screening - ANS first prenatal visit at least once in second and third trimester six week post party visit repeated screening at 6 and or 12 months in OB and primary care settings 3,9,12 month pediatric visits evidence based screening tools - ANS EPDS, PHQ EPDS - ANS score greater than 10 indicates the presence of depressive symptoms 0-6 no or minimal depression
7-13 mild depression 14-19 moderate depression 19-30 severe depression it is a screening tool. does not diagnose question #10 regarding self harm requires immediate follow through Patient Health Questionnaire (PHQ-9) - ANS A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression. validated for perinatal use, but not exclusively for that purpose Postpartum depression screening scale (PDSS) - ANS first 7 questions are short form. if >14, long form should be administered. seven sub scales: sleeping and eating disturbances, anxiety and insecurity, emotional lability, cognitive impairment, loss of self, guilt and shame, contemplating self harm. targets both symptoms and risk factors underdiagnosed bipolar disorder - ANS 22% of women who screen positive n EPDS at >10 had bipolar. 50% of women with treatment resistant postpartum depression actually suffered from Bipolar disorder 1 Mood Disorder Questionnaire (MDQ) - ANS Screens for Bipolar Disorder MDQ plus EPDS improved the distrinctionof unipolar depression from bipolar depression at the level of screening in 50% of women. ACE - ANS Adverse Childhood Experiences abuse, neglect, house hold dysfunction Culture - ANS the enduring behaviors, ideas, attitudes, and traditions shared by a large group of people and tr ANS mitted from one generation to the next
- education 2.sleep/rest
- nutrition
- exercise and time for self
- sharing with non-judgmental listeners
- emotional support
- practical support
- finding supportive resources
- plan of action suicide risk factors in pregnancy - ANS when pregnancy is unwanted, especially when a termination was wanted, but could not get one; partner abandoned woman during pregnancy; issues of IPV; woman had prior pregnancy loss or death of children; medication stopped abruptly. less than 12 years education; major depressive disorder common therapeutic goals - ANS changing identity checking expectations with reality reducing perfectionism and comparison communication and conflict resolution anger management grief and loss resolution supports and referrals for connection CBT (cognitive behavioral therapy) - ANS teaches clients to identify, evaluation and change dysfunctional patterns of thinking, resulting in mood and behavioral changes a collaborative approach, relaxation training, education about CBT
common CBT components - ANS assertiveness training, resiliency, cognitive restructuring, desensitization and exposure therapy cognitive restructuring - ANS a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs anxiety - ANS we overestimate the danger and underestimate our coping tools and ability to cope goals of CBT for anxiety - ANS reduce physical hyper vigilance, take away the danger, recognize anxiety as an alarm. increase perceived control and resilience, develop coping pl ANS and skills, exposure to feared symptoms and situations trauma psychotherapy-CBT - ANS collaborative, educate, reconceptulaize the problem as a more hopeful formation, retelling or restoring process, shattered assumptions and rescripting CBT for OCD - ANS relabel, reattribute, refocus, revalue relabel - ANS notice and name the thoughts, it's just a thought reattribute/reframe - ANS increase awareness of cognitive distortions, examine the evidence refocus - ANS shift attention away from the worry/fear, refocus behavior on a pleasurable activity in the moment revalue - ANS thoughts do not equal actions, just a thought, show self compassion and positive self talk
types of attachment - ANS secure-baby uses parent as secure base, can be soothed, can be independent insecure-avoidant, ambivalent, disorganized prevalence of attachment types - ANS secure-60-75% avoidant-15-25% ambivalent-10-15% disorganized-less than 14% disorganize in up to 62% in depressed mothers and 82% of maltreated infants Infant Mental Health - ANS "The developing capacity of the child from birth through 3 years of age to experience, regulate and express emotions; form close and secure interpersonal relationships; and explore the environment and learn—all in the context of family, community and cultural expectations for young children." promoting positive attachment - ANS support and intervention, assessing disruption in bonding and attachment evidence based approaches to facilitate secure attachments. Impact of poor bonding and attachment - ANS dysregulated sensitivity and responses, mother self criticism, avoidance of connection, anxious mothering, isolation from social support couples therapy - ANS partner support has measurable effect off PMADS marital disharmony is most commonly cited non-biological "cause" of PMADS, promote effective communication, understanding and support between partners. St. John's Wort - ANS may reduce effectiveness of birth control. should not be taken what anti- depressants. contraindicated for bipolar
bright light therapy - ANS consider use if symptoms occur during fall/winter 7,000-10,000 lux acupunture - ANS benefits pain, nausea, sleep contraindicated for inducing labor mixed benefits regarding mood probiotics - ANS microbiome-gut-brain axis role in mental health. som have shown benefit in reducing depression and anxiety, benefit in reducing colic in infants and symptoms of PPD placental encapsulation - ANS no evidence of iron benefits, no different in postpartum mood, bonding, or fatigue, no improvement in mood, energy, lactation, or plasma vitamin B12 levels epigenetic adaptation - ANS biological mechanism through which our environment of relationships, physical, chemical, and built environments, and early nutrition cause the physiological adaptations and disruptions that can influence a lifetime of well-being. medications for depression/anxiety - ANS SSRI (selective serotonin reuptake inhibitor) Sertraline (SSRI) - ANS Zoloft starting dose 25 mg 50-200mg range most commonly prescribed during pregnancy and postpartum Citalopram (SSRI) - ANS Celexa starting dose 5 mg 20-40mg range Escitalopram (SSRI) - ANS Lexapro
bupropion - ANS Wellbutrin augmentation for partial response to SSRI Mirtazapine (Remeron) - ANS Atypical antidepressant: Can also be used as sleep aid and for hyperemesis gravidarum Vortiozetine - ANS trintellix- new medication, don't start in pregnancy/postpartum, but don't stop is already stable tricyclic antidepressants-definition - ANS 3rd line. only consider after failing multiple SSRI and SNRIs Anxiolytics - ANS Drugs that alleviate the symptoms of anxiety. Buspirone (Buspar) non-benzo anxiolytics - ANS Antianxiety hydroxyzine (non-benzo anxiolytics) - ANS Vistaril Quetlapine (Seroquel) non-benzo anxiolytics - ANS atypical antipsychotic Anxiolytics: Benzodiazepines - ANS Treat: anxiety, mangement and chronic alcohol withdrawal syndromes. xanax, klonopin, Ativan SSRIs - ANS Zoloft, celexa, lexapro, Paxil, prozac
SNRIs - ANS Cymbalta, Effexor, Pristiq Atypical Antidepressants - ANS Wellbutrin, remeron, trintellix tricyclic antidepressants - ANS norpramin, pamelor, elavil Non-benzodiazepine used as an anxiolytic - ANS buspar, vistril, Seroquel Benzodiazepines - ANS xanax, klonapin, Ativan brexanolone-zulresso - ANS medication for moderate to severe PPD. IV dose, inpatient stay, usually symptoms reduced within 24 hours.
