Perinatal Mental Health Exam 1 Questions with Answers Best Rated A+, Exams of Nursing

Download Perinatal Mental Health Exam 1 Questions with Answers Best Rated A+ and more Exams Nursing in PDF only on Docsity!

Perinatal Mental Health Exam 1 Questions with Answers

Best Rated A+

1. What is a PMAD? - Correct Answer A perinatal mood and anxiety disorder (not just PPD!)
2. Define the perinatal period. - Correct Answer Time from conception through 1st year after giving birth.
3. Define the prenatal or antenatal time - Correct Answer During pregnancy
4. Define the postpartum or postnatal time - Correct Answer 1st year after giving birth
5. What does PMAD mean? - Correct Answer Perinatal mood (depression, bipolar, psychosis) anxiety (ocd, panic, had, ptsd) disorders (impact daily functioning).
6. Can occur at anytime in life but increased risk in perinatal period and symptoms have unique presentation.
7. How many infants annually are born to depressed mothers? - Correct Answer 400,000...making perinatal depression the most under diagnosed obstetric complication in America
8. PMADs can affect... - Correct Answer Anyone!
9. They do not discriminate. Can affect anyone. Socioeconomic status is NOT protective
10. _ in _ women are affected by perinatal depression - Correct Answer 1 in 7 women
11. Percentage of pregnancy induced HTN vs pre-eclampsia vs gestational diabetes vs PMADs? - Correct Answer 6-8% PIH, 6-8% pre-eclampsia, 6% gestational diabetes, 21% PMADs
12. _ in _ men are affected by perinatal depression - Correct Answer 1 in 10 men
13. Risks of untreated PMADs - Correct Answer Relationship problems, poor adherence to medical care, exacerbation of chronic medical issues, loss of

financial resources, disability, child neglect/abuse, developmental delays, tobacco/alcohol, drug use, Suicide, homicide

14. How many pregnancies are unplanned? - Correct Answer 50% Not all pregnancies are planned, wanted. Not all pregnancies end with a health baby or fulfillment.
15. Etiology of PPD? - Correct Answer Genetic predisposition, biological sensitivity to hormonal changes, social/environmental (Hx of trauma or poor social support), psychological (relationship with own mom, self image/perfectionism)
16. Cultural considerations of ppd - Correct Answer -in some cultures mothers may not feel safe to express needs or seek help.
17. -may report symptoms differently based on culture
18. What did the landmark study on PPD show? - Correct Answer 22% of women had depression during first year postpartum: 26% started before pregnancy, 33% during pregnancy, 40% during postpartum
19. Of the 22% of postpartum mothers - Correct Answer 68% had unipolar depression 66% had MDD or combo with GAD 22% bipolar depression 19% had thoughts of harming selves
20. Prenatal depression relapse rate with meds and without meds - Correct Answer 26% who continued meds relapsed during pregnancy while 68% who stopped meds relapsed
21. Higher relapse rate if you DC meds
22. Percent of fathers with PPD? - Correct Answer 10%
23. Depression in men: timing, symptoms - Correct Answer Peaks at 3- months postpartum
24. May not be sad "masked" and irritable, aggressive, hostile, acting out, checked out, distractions
25. Do men seek help for their depression? - Correct Answer Not often. Only 3% sought help.

Men are likely to under report symptoms

26. Single mothers vs single fathers - Correct Answer Single mothers: higher risk of maltreatment. Twice as likely than mothers with partners to have depression. Single fathers: have 3 times mortality rate than single mothers or partnered parents.
27. Trans gestational parents - Correct Answer Needs research to determine prevalence. Baseline depression and anxiety higher than adult average already.
28. Other people at risk - Correct Answer Non-gestational parents also at risk for PMADs.
29. Pregnancy VS Depression - Correct Answer Pregnancy-tearful, labor. No change in self esteem. Sleep disrupted due to bladder. No SI. Tire but rest restores, appropriate worry, joy, increase appetite
30. Depression: irritable, gloom, rage, low self esteem/guilt. Sleep changes, SI. Fatigue and no restoration of rest. Anhedonia
31. Characteristics of baby blues - Correct Answer 60-80% new moms affected Due to hormone fluctuation/sleep deprivation Lasts 2 days-2 weeks. Peaks 3-5 d.
32. Symptoms of baby blues - Correct Answer Tearfulness, liability, exhaustion
33. Predominately happy, self esteem unchanged Unrelated to stress or prior psych history Consider timing, onset, severity, duration, chronicity when differentiation between PPD and baby blues
34. Major unipolar depression with peripartum onset DSM criteria - Correct Answer 5 or more symptoms present for at least 2 weeks Depressed mood most of day Loss of interest/joy Weight change or appetite disturbance Sleep disturbance

Psychomotor agitation Fatigue Poor focus Worthless feelings Excessive guilty Recurrent thoughts of death/suicide

35. perinatal anxiety disorders - Correct Answer Includes GAD, panic
36. GAD DSM-5 Criteria - Correct Answer Excessive worry and anxiety (about ones own and babies needs) Difficulty controlling worry Agitation, irritable Restless, feeling on edge Poor concentration Fatigue, sleep disturbance (insomnia)
37. Increased somatic symptoms-muscle tension, palpitations, GI, SOB
38. Prevalence of perinatal anxiety - Correct Answer 15% Estimates between 8-20%
39. Panic disorder dsm criteria - Correct Answer Episodes of intense fear peaking in minutes SOB, chest pain, choking, dizzy Hot/cold flash, rapid HR, numbness Restless, agitation, irritable Excessive fear/worry Fear of going crazy or another attack No trigger sometimes
40. 3 greatest fears in panic disorder - Correct Answer Going crazy, death, losing control

41. Perinatal OCD - Correct Answer Obsessions defined by recurrent and persistent thoughts, urges, impulses that are intrusive and unwanted and cause anxiety. Compulsions are defined by repetitive behaviors that the individual feels driven to perform in response to the obsession. Behaviors or mental acts are aimed at preventing or reducing anxiety or distress.
42. Perinatal women how many times greater risk for ocd than general population? ____% had ocd onset in prenatal period - Correct Answer 1.5-2 times increase risk 32% had ocd onset in perinatal period
43. Perinatal OCD characteristics - Correct Answer Intrusive repetitive thoughts usually of harm coming to self and baby. They are EGO DYSTONIC-meaning not identifying with self. Very distressing. What if thinking Tremendous guilt and shame, horrified by these thoughts, hypervigilance. Mothers engage in behaviors to avoid harm to minimize triggers
44. Common presentations of perinatal ocd - Correct Answer 40% fears of deliberate harm 29% contamination 18% accidental harm 6% ordering/arranging 3%\3% religious and checking
45. Remember ... - Correct Answer Thoughts do NOT EQUAL action.
46. Key differences between perinatal OCD and perinatal psychosis - Correct Answer Ocd: parent recognizes thoughts are unhealthy, cause extreme anxiety/distress. Concerned with going crazy. DOES NOT want to carry out plans. Taken steps to protect baby. No hallucinations. Ego dystonic
47. Psychosis: parent does not think thoughts are bad. Have less anxiety indulging in thoughts. No insight on distortion of thoughts. Ego

syntonic***acceptable and they want to act on them. Delusions about baby- they are a demon.

48. What is trauma? DSM - Correct Answer The stressor (criteria A) -directly experiences the traumatic event. Witnesses it in person. Indirect exposure (providers), causes clinically significant distress and impairment in function not of a result of another medical problem, Med or substance use.
49. 4 subcategories of PTSD - Correct Answer Symptoms that follow last more than 1 month after event
50. Intrusion
51. Avoidance
52. Negativity in cognitions and mood
53. Arousal
54. Explain intrusion - Correct Answer Flashblacks, nightmares, somatic complaints, distressing memories, physical reactivity
55. Explain avoidance - Correct Answer Constricted emotions, social withdrawal, denial, apathy, avoidance, emotional numbing
56. Explain negativity in cognitions and mood - Correct Answer Guilt, depression, irritable, hopeless, negative thoughts, persistent sense of blame, decreased pleasure
57. Explain arousal - Correct Answer Sleep disturbance, poor concentration, hyper vigilance, aggression
58. PTSD prevalence - Correct Answer Approximately 4% in community setting and 18% in high risk groups. Can happen due to birth trauma. Actual or threatened serious injury or death to mother or infant.
59. Examples of potentially traumatic birth events - Correct Answer Emergency c section Postpartum hemorrhage Prematurity Nicu admission Severe pre eclampsia HG Traumatic vaginal birth Fetal anomaly dx in pregnancy Long labor Failed epidural

56. How many women per year die in childbirth? - Correct Answer 1, women And racial disparities exist! Highest in black women (43 per 100,000) vs 12 per 100,000 in white women
57. What is a maternal near miss? - Correct Answer A maternal near miss is an event where an individual nearly dies due to pregnancy or childbirth related complications. The events are unexpected and the survivor feels alone.
58. Difference between bipolar 1 and 2 - Correct Answer Bipolar 1: maniac and severe depression-swings between these two Bipolar 2: less severe mania (hypo mania) and severe depression
59. Bipolar 1 DSM criteria - Correct Answer At least one lifetime episode of mania -elevated mood symptoms: euphoria, decreased sleep need, racing thoughts, increased productivity, increased energy -hypo mania episodes: 4 days in length, improved functioning -mania episodes: severe symptoms, impaired function, 7 days in length, requires hospitalization or psychotic symptoms (hallucination, paranoia, disorganized thoughts)
60. What percent of women present as depressed? - Correct Answer 60% of those with bipolar 1 present as depressed initially 50% of women with bipolar are first diagnosed in the postpartum period! Bipolar is a huge risk for psychosis!
61. Bipolar is high risk for... - Correct Answer Psychosis! It occurs in 20-30% of those with bipolar. Many of those with bipolar experience relapse during pregnancy and postpartum
62. What is the ppd imposter? - Correct Answer Bipolar 2: hypo mania and severe depression. Often presents with depressive symptoms and resistant to SSRIs often.
63. How common is perinatal psychosis? - Correct Answer 1-2 in 1000 women experience this.

5% die by suicide. 4% commit infanticide 50% never had past history of psych issues

64. When does perinatal psychosis occur? - Correct Answer Usually 2 weeks postpartum, rapid onset.
65. Risk factors for psychosis - Correct Answer First child DC mood stabilizer Complications Perinatal loss Previous bipolar, or psychosis (30% recurrence) Family history of these Sleep deprivation Key is to stay on meds or start immediately postpartum
66. Postpartum psychosis onset, cognition, behavior, mood, speech - Correct Answer Onset: 2 weeks-1 year Behavior: agitation, hyperactive, distant, aloof, no self care Mood: elated, labile, dysphoric Speech: rambling
67. Psychosis thought content - Correct Answer Thought broadcasting Ideas of reference Infant being harmed Persecution, jealously, paranoid Being controlled Delusion of grandiosity
68. thought process - Correct Answer Disorganized, flight of ideas.
69. Perceptions (psychosis) - Correct Answer Hallucinations-commanding auditory Organic (visual, olfactory, tactile)

70. How do you reduce risk of postpartum psychosis? - Correct Answer Women with bipolar should remain on medication during pregnancy Initiate treatment immediately postpartum in those with history of psychosis Good sleep!!!! Almost all individuals achieve full remission! 29% risk of recurrence
71. PPD in dads parenting consequences - Correct Answer Irritability/anger towards kids. Decreased positive parenting behaviors 4 times more likely to report spanking. Child more at risk of developing depression at 18 y/o
72. Risk factors for PMADs - Correct Answer Psychiatric history: family or personal history of PMADs, family or personal history of anxiety, ocd, etc. history of childhood sexual abuse Significant mood reactions to hormonal changes: PMS, PMDD, OCPs, abrupt DC breastfeeding
73. Long term effects of childhood sexual abuse - Correct Answer Mental health challenges are more likely. Drug abuse can happen also. 4 times more likely to experience PTSD.
74. More risk factors for PMADs - Correct Answer Endocrine dysfunction: DM (34% more common) thyroid, fertility challenges Social factors: inadequate partner support, violence, financial, childcare, loss, moving, racism, SAD
75. Other risk factors for PMADs - Correct Answer Lack of sleep Pain Grief or loss: neonatal death, abortion, or loved ones death Pregnancy or birth complications Baby temperament or health issues

Perfectionism

76. How many percent or women use drugs during pregnancy? - Correct Answer 5% or 1 in 20! But in ages 15-17 it is much higher at 14%!
77. Prevalence of cannabis use in pregnancy & adverse effects - Correct Answer 2-5% Neurodevelopment can be impacted. But limited research exists.
78. Risks of substance use? - Correct Answer Stillbirth. Around 2 times the risk of stillbirth if using tobacco, marijuana, stimulant or painkillers
79. Prevalence of alcohol use postpartum and drug use in general? - Correct Answer Alcohol: 40-49% Drug use: 4-8% Many times substance use was associated with very high rates of PMADs (46%!)
80. What is neonatal abstinence syndrome? - Correct Answer NAS is when an infant becomes dependent on opioids or other drugs used by the mother in pregnancy. The rate of this is increasing!
81. Opioid use disorder resource - Correct Answer SAMHSA.GOV Substance abuse and mental health services administration The rate of women with opioid use disorder quadrupled from 1999-
82. Breastfeeding recommendations - Correct Answer AAP recommends to breastfeed for the first 6 months postpartum, exclusively, except for vitamin D supplementation. Human milk is sufficient to support optimal growth and development for the first six months followed by introduction of solids. Human milk should be continued until the first year of life.
83. As a clinician re: breastfeeding - Correct Answer Providing support, info, and encouragement to breastfeed is half the clinicians responsibility. Women have the right to choose not to without guilt.
84. Breastfeeding & depression - Correct Answer Breastfeeding & depression have a bidirectional relationship. BF-ing may support maternal mental health. Less likely to be depressed. Depression/anxiety also leads to lower BF rates and earlier cessation.

85. Moms on meds for depression breastfed longer than those with untreated depression. Prenatal anxiety or depression returned after stopping BF for some women.
86. What is Dysphoric Milk Ejection Reflex - Correct Answer Dysphoric Milk Ejection Reflex is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes. It is like a wave of emotion. It is NOT psychological it's physiological. It's a reflex controlled by hormones!
87. 3 different emotions women feel during D-MER - Correct Answer Despondency: hopeless, sadness, negative emotions (mild-mod-severe) Anxiety; moderate to severe. Dread, restless Agitation: anger, agitation, paranoia. Almost always is severe.
88. How does depression effect lactation? - Correct Answer Depression suppresses oxytocin and prolactin-which are essential to lactation. Also suppressed with c section, stressful birth, epidurals and other interventions
89. Things that can also decrease milk supply? - Correct Answer Reglan (galactagogue) increased depression 7 times Thyroid dysfunction and anemia reduce supply and cause depression too
90. Race and breastfeeding relationship? - Correct Answer African American infants had lowest rates of breastfeeding.
91. Race issues related to PMADs? - Correct Answer Higher rates of birth trauma and high rates of PMADs in African Americans Lower rates of breastfeeding also
92. Breastfeeding support - Correct Answer For black mothers: black mothers breastfeeding association. Facebook groups Non-binary gender: la leche league transgender and non binary parents. FB groups queer liquid gold.
93. teen pregnancy rate - Correct Answer 1 in 4 teens get pregnant by age 20 Birth rates are falling, to an all time low in 2011

10% for women ages 15-17 and 6% for women ages 18- Higher in US than other countries

94. Medical risks for teen moms - Correct Answer HTN, anemia, nutritional, early/preterm labor, low birth weight, STI, increased mortality, obstructed labor
95. Risk factors for PMADs in teens - Correct Answer Untreated depression in their mother Social isolation/peer rejection Weight Low maternal self esteem/efficacy Family issues and physical/sexual abuse
96. How common is teen fatherhood? - Correct Answer 10 births per 1000 80% of fathers would be upset to get someone pregnant. Less likely to finish high school
97. Military families demographics - Correct Answer More than 43% serving are young (<25) 55% marrried and enter parenthood early. Many have kids (42%) 80% male and 20% female
98. Military PMAD risk and networks - Correct Answer Deployment of spouse during pregnancy associated with 3 fold increase for preterm delivery and 3 times increased for ppd. Military support network Psi has an online support group every Wednesday
99. Are OB/GYNs educated on women with disabilities? - Correct Answer No, only 19% surveyed feel they have knowledge to care for those with disabilities.

And women with disabilities perceive their HCP with negative attitudes about motherhood and childbearing

100. Prenatal experience of women with disabilities - Correct Answer Their disabilities were a big factor in selecting their obgyn Hard to find informed providers 40% of them reported their docs did not know how their disability would affect pregnancy Exam tables, scales, etc were not accessible to them due to disabilities.
101. Percentage of newborns in nicu? - Correct Answer 10-15% per year need nicu admission
102. Nicu parents and PMADs - Correct Answer Becoming a nicu parent increases rates of depression and anxiety. Very traumatic for parents and child. Life changing/traumatic event. Witness to multiple traumatic events: labor, birth intervention, nicu, airlifting/separation, code blue, nicu waiting room, surgery, etc
103. How many parents suffer mental health issues after nicu admission for their child? - Correct Answer 20-30% in first year postpartum suffer a diagnosable mental health disorder Mothers 23-60% PPD, 30% anxiety, 33% SI Subclinical PTSD—they may avoid visitation, attachment with baby issues, g&d issues with baby
104. After nicu how parenting can be: - Correct Answer Adjustment to life at home with baby, no support staff. Hyper vigilance, continued home isolation. Fragile infant at home w follow up care. No monitors at home
105. Miscarriage increases risk of what PMAD? - Correct Answer PTSD and OCD (anxiety) Women with history of loss have increased levels of depression and anxiety w subsequent pregnancies. Upside: 50-80% of these women become pregnant again.
106. How many pregnancies end in miscarriage?

Percent in first trimester? 2nd? 3rd? - Correct Answer 15% of pregnancies end in loss 80% occur in 1st trimester 14% occur in 2nd trimester 6% occur in 3rd trimester

107. Define neonatal loss and what is neonatal mortality rates and main causes

- **Correct Answer** Neonatal death is loss of an infant during first 28 days of life. 3.9 deaths per 1000 live births. 

Worse outcome in racial minorities 23,000 per year. Common causes: congenital anomalies.

1. Birth defects
2. Preterm/low birth weight
3. Maternal pregnancy complications
4. SIDS
5. Injuries
6. Define infertility and percent of women that experience this - Correct Answer Infertility is not being able to get pregnant after regular intercourse within 1 year of trying OR only after 6 months if aged 35 or older. 10% of women 15-44 have difficulty. 1 in 8 couples. Worse in racial minorities.
7. How infertility impacts mental health - Correct Answer Isolation, loss of how things should work, depression rates are high. Increase stress on relationship and in increased financial stress. Surrogates have 22% higher rates of PMADs when carrying for gay males. Donor involvement can complicate patently. Costly for do ART, adoption, etc.
8. Twin birth rate? And impact on mental health? - Correct Answer 33.3 per 1000 live births twins Triplets or more 101 per 100,000 live births Increased depression, anxiety and stress on parents. 31% had perinatal depression!

111. Highest stressors of parents of multiples - Correct Answer Caring for more than 1 baby Delivery complications Financial problems Marital problems Nicu/sick babies
112. Domestic adoption rate - Correct Answer 0.5% of all live us births are adoption 4,059 intercontinental adoptions to the US
113. Barries with adoption - Correct Answer Complication relationships-birth mother and adoptive mother. LGBTQ people parent through adoption. They face significant barriers to adoption. Further research needed to eval mental health impact of this on them.
114. What is PADS? - Correct Answer Parental post adoption depression syndrome Depressive state of the adoptive/intended parent after placement of a new child in their home. When dissonance occurs between parental expectations created pre placement and the reality that is faced, depressive symptoms may emerge.
115. Prevalence of PADS - Correct Answer 18-26% in mothers 11-24% in fathers Most common challenges: self esteem, history of depression, perceived friend support, marital satisfaction, parent to child bonding.
116. Primary prevention of PMADs - Correct Answer -screening! Highest period of risk is 3 months postpartum.
117. -all postpartum women and families should get rest, exercise, nutrition. -educate them on PMADs and symptoms and treatment (meds) -create support plan. Get help! -managing to do list. Meal planning

-sleep hygiene

118. Explain sleep hygiene practices - Correct Answer No electronics 30- min prior to bed Go to bed when sleepy Avoid alcohol, caffeine late in day. Warm bath, protein snack before bed Dark environment. Get help at night
119. Cultural rituals that help the mom postpartum - Correct Answer -6- weeks postpartum some cultures provide mandated rest for mom. Social seclusion. A time for mother to recuperate emotionally and physically. -offer special meal, keep mother and infant warm -mother gets help with all duties except reading and breastfeeding. -social recognition of new role, celebration of her after her rest period
120. Reasons to screen for PMADs - Correct Answer High prevalence Effective screening and treatment Reduces risk of continued depression at 3-5 months by 18-59-% Early detection helps!!! High risks of untreated PMADs!
121. Do screening instruments help? - Correct Answer Rate of detection is higher with use of screening tool such as EPDS. Edinburgh postpartum depression screening. Despite these tools-Pmads still undertreated and underdiagnosed.
122. Barriers to screening for PMADs-provider concerns - Correct Answer Time consuming, expensive Unsure about treatment if positive screen Unaware of validated tools Fear of liability if screen positive and not treated

123. What are the outcomes from better screening for PMADs? - Correct Answer Reduce prevalence of depression, increase remission rates/treatment response Id at risk! Shorter depression period if early intervention
124. Who should screen and how often? - Correct Answer Anyone that meets with childbearing families First prenatal visit Once in second trimester and once in 3rd trimester 6 week postpartum visit Repeat screenings at 6 and 12 months in OB or PCP setting *****Also at 3, 9 and 12 month pediatric visits!!!!
125. How to implement screening? - Correct Answer Pencil-paper or computerized in waiting room. Provide cover sheet explaining why screening. Write "please be open and honest" on the questionnaire. Provider reviews and addresses in visit Assess for safety prior to them leaving Offer privacy. Cultural and language considerations. Make it standard to screw all new parents!
126. Two validated tools for depression - Correct Answer Edinburgh Postnatal depression scale -validated tool, in many languages, 10 item self reported, validated with teens, dads and preggos 0-6 (minimal or none) 7-13 (mild) 14-19 (moderate) 19-30 (severe) Phq9: 9 item self reported questionnaire Correlates with DSM criteria and many languages

127. Note for these screening tools - Correct Answer There are also shortened versions of both PHq-2 and EPDS2 short version. Both are very accurate at identifying But neither assess for suicidality-so you must ask these questions!!!!
128. One more tool for PPD - Correct Answer Postpartum depression screening scale 35 questions, likert scale 3rd grade reading level Better measure of symptoms Good reliability for mothers carrying children with fetal anomalies and in nicu
129. Bipolar screening tool - Correct Answer 50% of treatment resistant depression had bipolar 1! Also if positive EPDS screen, could have bipolar 1 Mood Disorder Questionnaire If you use MDQ plus EPDS you can differentiate between depression and bipolar one better.
130. What is the ACEs screening tool for? - Correct Answer Adverse Childhood Experiences, screens for childhood trauma. Evaluated abuse, neglect and household dysfunction! The ACE study linked childhood abuse and household dysfunction to many leading causes of early death.
131. The higher the ACEs score... - Correct Answer The greater likelihood of emotional problems, heath risk behavior, social problems, poor life expectancy. Also more adverse childhood experiences a women goes through they have pregnancies that lead to deceased birth weight.
132. Urban ACES - Correct Answer 7 in 10 adults in philly experienced on ACE! Need an expanded urban ACE questionnaire-40 questions. Ask about racism, poverty, bullying, neighborhood issues, etc

133. How is trauma and culture connected? - Correct Answer Context and culture plays a role in how people perceive and process traumatic events
134. What is trauma informed care? - Correct Answer Highlights adaptation over symptoms. Resilience over pathology. Avoid institutionalized policies that can re traumatize someone. Listen, validate, sustain safety, assess own bias, choice, autonomy, cultural humility, collaboration
135. What does it mean to switch from culturally competent to cultural humility?

• Correct Answer It is focused on others not ourselves Learning process continues Lifelong commitment Develop mutually exclusive patient provider relationships. Eliminate the power imbalance

136. biological weathering - Correct Answer Chronic exposure to racism can dysregulate HPA axis and lead to physical outcomes such as CVD and obesity. Rewire the brain and predispose to anxiety and psychosis
137. What is culture? - Correct Answer The shared elements involving in perceiving, believing, evaluating, communicating, and acting that are passed down from generation to generation with modifications. Influences all conscious and unconscious decisions
138. How to set up intake - Correct Answer Connect, may need several sessions, meet with mother alone first. Demographic and psychosocial history. Use screening tools. Collect pregnancy, prenatal, fetal and medical history
139. Parts of a history you should collect - Correct Answer Pregnancy history Prenatal and fetal history Medical history Newborn history Sleep hygiene Mental health history Social and spiritual history Risk factors
140. Parts of a pregnancy history - Correct Answer Number of pregnancies

History of infertility Living children Pregnancy or PP complications Children living with you?

141. Prenatal and fetal history - Correct Answer Planned or unplanned pregnancy? Medical complications? Fetal or mother? How are you feeling this pregnancy?
142. medical history - Correct Answer Any previous medical problems prior to pregnancy? PMS/PMDD 10-15% hypothyroidism in postpartum
143. Parts of a newborn history - Correct Answer Birth story-birth trauma/NICU admissions Baby's temperament Read baby's cues? Help with childcare? How is child fed?
144. What to assess re: sleep hygiene - Correct Answer -how many hours do you sleep per night -difficult falling or staying asleep -help at night with baby? -how many times do you wake up? -who else is sleeping in bed?
145. Mental health history components - Correct Answer Any history (personal or family) of depression or anxiety? Psych meds in past? Taking any meds OTC or herbs? What else helped in past?
146. Social history components - Correct Answer -sources of support: relationship with partner, any safety concerns, intimacy challenges? -level of partners involvement -social network—family/friends, meal trains, etc Spiritual Networks components
147. Difference between spirituality and religion - Correct Answer -faith or spiritual practice? -how involved are you? Does your partner have the same faith?

148. Spirituality is personal experience of ordering our consciousness to make sense of our lives, our circumstances, and our experiences-does not always include a higher power Religion is an organized and structured approach to spirituality
149. Risk factors for mental health r/t pregnancy - Correct Answer Substance abuse and use? Caffeine intake, tobacco, alcohol and other drugs prior to pregnancy? AND during? Treatment for substance use before? Any sober groups: AA, NA
150. Intrusive thinking: how can you assess for this? - Correct Answer It is really common for women to experience intrusive or scary thoughts can you share any that you might have? Thoughts of hurts the baby?
151. Other risk factors for mental health issues - Correct Answer Eating habits (gerd, weight loss/gain, and feelings about this) Body image concerns and history of E.D's? Losses in family, moving etc
152. What is one thing that a women says that makes her a high risk for suicide? - Correct Answer When she thinks the baby would be better off without her
153. Suicide risk factors in pregnancy - Correct Answer When a pregnancy is unwanted Intimate partner violence Low education Prior pregnancy loss or death of children Psych illness or meds stopped abruptly *pregnant women are more likely than the general population to endorse SI

154. Prevalence of suicide is higher in which groups of pregnant women? - Correct Answer 10% of suicide behaviors was in 12-18 year old group of pregnant women. Higher in low income or African American
155. What would be considered a positive Suicide screen? And what steps do you take? - Correct Answer EPDS question 10: the thought of harming myself has occurred to me Phq9: thoughts that you would be better off dead-any score greater than 0 is positive Assess, refer and follow up!!!! Needs a same day comprehensive suicide risk assessment. Document interaction and safety plan. Can use Columbia suicide severity rating scale
156. When a positive screen? - Correct Answer Clarify roles, availability and ability to help Give resources: 24 crisis lines, urgent care, reliable phone and website. Refer for med eval. Get permission to communicate with support system
157. What do you do if a client is unsafe? - Correct Answer Consider hospitalization Advise family and patient you need to keep them safe. Do not need consent if it's an emergency. Find someone to take care of kids and instruct others not to leave them alone. Can call CPS if you do not feel kids are safe and do not need to ID yourself
158. When to send to ER or call 911 - Correct Answer Suidicial or homicidial ideation with plan and intent Acute mania Psychosis Call ER to facilitate
159. Who is in the treatment team? - Correct Answer Health care providers, psychiatrists, pharmacists, case workers, doulas, childbirth educators, lactation consultants, spiritual affiliates (pastors, rabbi, hospital chaplain) Includes follow up and care postpartum. Starts prenatally. Accessible and flexible to meet all needs

160. From screening to treatment - Correct Answer Women will agree to getting screened for a mental health issue but little will agree to treatment (stigma still exists) 92% agreed to screen. 30% with positive agreed to get help but <half showed up to get help.
161. What is the stepped model approach to care? - Correct Answer Stepped care models match severity and complexity of symptoms to the appropriate level of care. It's a system of delivering and monitoring treatments so that the most effective but least resource intensive treatment is delivered first: only stepping up to intensive services as clinically required. These improve quality of care, satisfactory and depression outcomes
162. Factors to consider when referring - Correct Answer Does the provider specialize in PMH-C? Does the provider do sliding scale? Will they let them bring baby to session? Give multiple referrals, in person/online support groups, community resources also PSI has a PMH provider directory also
163. Facilitation of the referral process - Correct Answer -educate patient about the psych NP or psychiatrist training -assess if OB will start tx or PCPs -explain current diagnosis to referral, help the patient make the call. Have patient sign release of info if you will be therapist for Pt still. -be patient and follow up, it is hard for them to follow through sometimes
164. What does PSI believe about social support? - Correct Answer Women are not alone, not to blame and they will get better with informed help. Support must include empathy, information, and practical help. Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated in a social network. It is time for every community around the world to value, honor, and support mothers, fathers, partners, and families not only in words but in action
165. Social support network examples - Correct Answer Family Friends

Telephone support Email/online Peer group

166. Support group vs therapy group - Correct Answer Support: facilitator guides process and intervenes when needed. Participants support each other, gives feedback/suggestions. Usually open at all times to new members & support person sometimes included Therapy: facilitator is a professional health care or mental health provider, more focus on group dynamics, closed group for specific time frame. May allow couples and may not
167. Options for perinatal support grohos - Correct Answer Open vs closed, informed consents, fees, time of day, allow children? Partners or family welcome?
168. Different perinatal support groups - Correct Answer POEM: perinatal outreach & encouragement for mothers This isn't what I expected Baby blues connection Mother baby support group
169. Things talked about at group - Correct Answer Guidelines, check in, self care, group goals Confidential, non judgmental, safe space, how was your week? Sleeping? Eating? What will you do for just you this week? Topics: sex, in laws, sleeping, unwanted advice, partners, mindfulness,
170. Role of social support facilitator - Correct Answer -self help volunteers and supporters provide empathy. Listen without giving advice! -survivors are role models and living proof you can become well. -active listening, no judgement -know facts and up to date on research. -provide written materials, emergency treatment -telephone support/warm line (reduced mild depression symptoms)
171. Jane Honikman's community support for new families - Correct Answer She created a workbook divided in 6 stages/steps to create a new support network

1. Brainstorm 2. Investigation 3. Planning 4. Implement 5. Evaluation 6. Future endeavors 172. 9 steps to wellness by Jane Honikman - Correct Answer Education Sleep Nutrition Exercise/time to self Non judge mental sharing Emotional support Practical support Referrals and other resources Plan of action: break down goals into small steps! One thing you'll do for self this week
2. Briefly name the 4 types of psychotherapy treatment models - Correct Answer 1. Cognitive behavioral therapy (individual/group)
3. Interpersonal psychotherapy (individual/group)
4. Mother-infant attachment
5. Couples counseling
   174. goals of psychotherapy - Correct Answer Changing identity Checking expectations with reality Reducing perfectionism/comparison Communication & conflict resolution Anger mgmt Grief/loss Connection
6. What is CBT teach, what conditions is it helpful for? - Correct Answer Teaches clients to ID, evaluation, and change dysfunctional patterns of thinning, resulting in mood and behavioral changes. Prevention and treatment of perinatal depression & anxiety. CBT and interpersonal therapy used for PPD
7. What is mindfulness CBT? Goal? What is the 3 minute breathing space technique? - Correct Answer The goal of mindfulness CBT helps individuals learn how to avoid relapses by not engaging in automatic thought patterns that perpetuate and worsen depression and learning to observe and accept one's experience. 3 minute breathing space technique -observing ones own experience (how are you doing right now) -focusing on the breath attending the body and physical sensations