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Perinatal Mental Health Exam 2025 (Newest Exam)
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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 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
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 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 Social support network examples ---------CORRECT ANSWER-----------------Family Friends Telephone support Email/online
Explain intrusion ---------CORRECT ANSWER-----------------Flashblacks, nightmares, somatic complaints, distressing memories, physical reactivity Explain avoidance ---------CORRECT ANSWER-----------------Constricted emotions, social withdrawal, denial, apathy, avoidance, emotional numbing Explain negativity in cognitions and mood ---------CORRECT ANSWER----------------- Guilt, depression, irritable, hopeless, negative thoughts, persistent sense of blame, decreased pleasure Explain arousal ---------CORRECT ANSWER-----------------Sleep disturbance, poor concentration, hyper vigilance, aggression 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. 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 How many women per year die in childbirth? ---------CORRECT ANSWER-------------- ---1,200 women And racial disparities exist! Highest in black women (43 per 100,000) vs 12 per 100,000 in white women 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. Difference between bipolar 1 and 2 ---------CORRECT ANSWER-----------------Bipolar 1: maniac and severe depression-swings between these two
Define the prenatal or antenatal time ---------CORRECT ANSWER----------------- During pregnancy Define the postpartum or postnatal time ---------CORRECT ANSWER----------------- 1st year after giving birth What does PMAD mean? ---------CORRECT ANSWER-----------------Perinatal mood (depression, bipolar, psychosis) anxiety (ocd, panic, had, ptsd) disorders (impact daily functioning). Can occur at anytime in life but increased risk in perinatal period and symptoms have unique presentation. How many infants annually are born to depressed mothers? ---------CORRECT ANSWER-----------------400,000...making perinatal depression the most under diagnosed obstetric complication in America PMADs can affect... ---------CORRECT ANSWER-----------------Anyone! They do not discriminate. Can affect anyone. Socioeconomic status is NOT protective
_ in _ women are affected by perinatal depression ---------CORRECT ANSWER------- ----------1 in 7 women 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 _ in _ men are affected by perinatal depression ---------CORRECT ANSWER----------- ------1 in 10 men 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 How many pregnancies are unplanned? ---------CORRECT ANSWER----------------- 50% Not all pregnancies are planned, wanted. Not all pregnancies end with a health baby or fulfillment.
Prenatal depression relapse rate with meds and without meds ---------CORRECT ANSWER-----------------26% who continued meds relapsed during pregnancy while 68% who stopped meds relapsed Higher relapse rate if you DC meds Percent of fathers with PPD? ---------CORRECT ANSWER-----------------10% Depression in men: timing, symptoms ---------CORRECT ANSWER----------------- Peaks at 3-6 months postpartum May not be sad "masked" and irritable, aggressive, hostile, acting out, checked out, distractions Do men seek help for their depression? ---------CORRECT ANSWER-----------------Not often. Only 3% sought help. Men are likely to under report symptoms 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. Trans gestational parents ---------CORRECT ANSWER-----------------Needs research to determine prevalence. Baseline depression and anxiety higher than adult average already. Other people at risk ---------CORRECT ANSWER-----------------Non-gestational parents also at risk for PMADs. 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 Depression: irritable, gloom, rage, low self esteem/guilt. Sleep changes, SI. Fatigue and no restoration of rest. Anhedonia Characteristics of baby blues ---------CORRECT ANSWER----------------- 60 - 80% new moms affected Due to hormone fluctuation/sleep deprivation
Worthless feelings Excessive guilty Recurrent thoughts of death/suicide Perinatal anxiety disorders ---------CORRECT ANSWER-----------------Includes GAD, panic 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) Increased somatic symptoms-muscle tension, palpitations, GI, SOB
Prevalence of perinatal anxiety ---------CORRECT ANSWER-----------------15% Estimates between 8-20% 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 3 greatest fears in panic disorder ---------CORRECT ANSWER-----------------Going crazy, death, losing control
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 Remember ... ---------CORRECT ANSWER-----------------Thoughts do NOT EQUAL action. 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 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.
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! 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 What is the ppd imposter? ---------CORRECT ANSWER-----------------Bipolar 2: hypo mania and severe depression. Often presents with depressive symptoms and resistant to SSRIs often. 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
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 Psychosis thought content ---------CORRECT ANSWER-----------------Thought broadcasting Ideas of reference Infant being harmed Persecution, jealously, paranoid Being controlled Delusion of grandiosity thought process ---------CORRECT ANSWER-----------------Disorganized, flight of ideas. Perceptions (psychosis) ---------CORRECT ANSWER-----------------Hallucinations- commanding auditory
Organic (visual, olfactory, tactile) 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 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 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
