Perinatal Mental Health exam Questions and Answers (Latest Update 2024) Verified Answers, Exams of Nursing

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What is a PMAD? - Correct Answer ✅A perinatal mood and anxiety disorder (not just PPD!) Define the perinatal period. - Correct Answer ✅Time from conception through 1st year after giving birth. 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.

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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

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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. 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) Cultural considerations of ppd - Correct Answer ✅-in some cultures mothers may not feel safe to express needs or seek help.

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-may report symptoms differently based on culture 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 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 Prenatal depression relapse rate with meds and without meds

• Correct Answer ✅26% who continued meds relapsed during pregnancy while 68% who stopped meds relapsed

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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.

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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

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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. Symptoms of baby blues - Correct Answer ✅Tearfulness, liability, exhaustion 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

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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 perinatal anxiety disorders - Correct Answer ✅Includes GAD, panic

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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%

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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

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3 greatest fears in panic disorder - Correct Answer ✅Going crazy, death, losing control 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. 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

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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 Common presentations of perinatal ocd - Correct Answer ✅40% fears of deliberate harm 29% contamination 18% accidental harm

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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.

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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. 4 subcategories of PTSD - Correct Answer ✅Symptoms that follow last more than 1 month after event

1. Intrusion
2. Avoidance
3. Negativity in cognitions and mood
4. Arousal Explain intrusion - Correct Answer ✅Flashblacks, nightmares, somatic complaints, distressing memories, physical reactivity

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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

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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.

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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 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)

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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- in 1000 women experience this.

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5% die by suicide. 4% commit infanticide 50% never had past history of psych issues When does perinatal psychosis occur? - Correct Answer ✅Usually 2 weeks postpartum, rapid onset. Risk factors for psychosis - Correct Answer ✅First child DC mood stabilizer Complications Perinatal loss Previous bipolar, or psychosis (30% recurrence) Family history of these

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Sleep deprivation Key is to stay on meds or start immediately postpartum 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

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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

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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

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Significant mood reactions to hormonal changes: PMS, PMDD, OCPs, abrupt DC breastfeeding 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. 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 Other risk factors for PMADs - Correct Answer ✅Lack of sleep Pain

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Grief or loss: neonatal death, abortion, or loved ones death Pregnancy or birth complications Baby temperament or health issues Perfectionism 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%! Prevalence of cannabis use in pregnancy & adverse effects - Correct Answer ✅2-5% Neurodevelopment can be impacted. But limited research exists.

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Risks of substance use? - Correct Answer ✅Stillbirth. Around 2 times the risk of stillbirth if using tobacco, marijuana, stimulant or painkillers 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%!) 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! Opioid use disorder resource - Correct Answer ✅SAMHSA.GOV