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PMH-C Exam Study Guide Review
1. Military Stressors: Recent/upcoming deployment Potential
lack of emotional support from partner Fear for welfare or self or partner Living without partner Single parenting Concerns about childcare Inadequate support: Location away from friends and family Possibility of no established relationships with recent move Lack of providers who understand military culture Lack of providers for beneficiaries Lack of providers who accept insurance Lack of peer support due to "army strong" mentality Lack of disclosure to others due to "small town" Lack of ability to provide peer support due to own needs Focus often on active duty member's psychological issuesv
2. Jane Honikman: Founder of PSI
3. What year was PSI established?: 1987
4. Louis Victor Marce: French psychiatrist who wrote first treatise on puerperal (about six weeks after childbirth)
mental illness
5. James A. Hamilton: Father of Postpartum Psychiatric Illness Wrote
book: Postpartum Psychiatric Problems Founded the Marce Society Advocate of research, treatment and social support movement
6. DAD: Depression After Delivery (USA)
7. APNI: Association for Post Natal Illness (England)
8. PANDA: Post and Ante Natal Depression Association (Australia)
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9. Postpartum Education for Parents: Postpartum Education for Parents (USA)
10. Most important part of mental health for women, children, and families: -
Social support
11. How many countries does PSI have members in?: Over 40 countries
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24. PMADs in Fathers: 1 in 10 men will get anxiety/depression
Fathers with higher ACE scores reported more pregnancy-related anxiety than did fathers with lower scores at all time points Reported more depressive feelings during pregnancy 9.2% had depression prenatally Maternal depression increased the risk of paternal depression
- Initial high after birth may give way to depression
- Masked male depression (substance use, irritable, aggressive)
- Distancing
- Distractions and habits
25. Medication: 50-75% relapse (depression and anxiety) after discontinuing medication while pregnant Over
40% resume medication during pregnancy The benefit out weights the risk when on medication during pregnancy
26. Normal Pregnancy symptoms: Mood is labile, teary
Self esteem is normal Sleep: bladder or heartburn may awaken. Can fall asleep No suicidal ideology Energy: may tire, rest restores Pleasure: joy and anticipation (appropriate worry) Appetite: increases
27. Depression Symptoms: Mood: persistent gloom
Low self-esteem, guilt Sleep: early a.m. awakening Suicidal thoughts, plans, or intentions Energy: rest does not restore Fatigue Anhedonia Poor appetite Sadness,
5 / 37 crying Guilt and shame Hopeless and helplessness Overwhelm Lack of feelings toward baby Isolation "This doesn't feel like me" Worthlessness Mood swings Inability to care for self and family
28. baby blues: -NOT a mild form of clinical depression
- Attects 60-80% of new moms
- Mild
- Lasts no more than 2 days to 2 weeks
- Predominant mood is happiness
- Common to have tearfulness, lability, reactivity
- Peaks 3-5 days after delivery
- Present in diverse cultures
- Unrelated to stress or psychiatric history
- Acute sleep deprivation -Ditterent in from PPD in length and severity
- Symptoms: mood swings, anxiety, sadness, irritability, crying, decreased concentration, trouble sleeping -Very common to feel this way, hormones have to readjust -Every mother experiences some type of baby blues, it's normal
29. Blues or Depression?: Severity
Timing Duration
7 / 37 Intrusive, repetitive thoughts (usually of harm coming to baby) (Ego-Dystonic thoughts) Tremendous guilt and shame Horrified by these thoughts Moms engage in behaviors to avoid harm or minimize triggers Client does NOT want to do these things (DCFS does not need to be called)
33. OCD prevalence: Perinatal woman are 1.5 - 2 times greater risk than general population Severity
remains largely unchanged across pregnancy and the postpartum period 30% new onset perinatal 11% of women at 2 weeks and 6 months postpartum 65% have co-morbid depression 41% fear deliberate harm 29% fear contamination
34. Trauma: Directly experienced, witnessed, or repeated exposure to adverse detail of a traumatic event Not
physiological result of another medical condition, medication, drugs or alcohol Overwhelming experiences that invoke intense negative attect and involve some degree of loss of control and/or vulnerability. The experience of trauma is subjective The experience of what happened is not as important as what it means to the individual
35. PTSD prevalence: 12.3% of women in general population
Over 12% of pregnant women 9% postpartum met PTSD criteria 18% elevated symptoms of stress Up to 34% of moms report a traumatic birth
36. PTSD Symptoms: Persistent and distorted sense of blame of self or others
Numbing Hyperarousal/hypervigilance Dissociation Markedly diminished interest in activities, to an inability to remember key aspects of the event Flashbacks and flooding Distressing memories, thoughts, feelings, or external reminders
8 / 37 Spontaneous memoires Recurrent dreams/nightmares Avoidance of triggers Isolation
37. Potentially Traumatic Events: Emergency C-Section
Postpartum hemorrage Premature birth NICU Forceps/vacuum Pre-eclampsia 3rd or 4th degree laceration Hyperemesis Gravidarum Traumatic vaginal birth
38. Birth Trauma: An event occurring during the labor and delivery process that involves actual or threatened serious
injury or death to the mother or her infant The birthing woman experiences intense fear, loss of dignity, helplessness, loss of control, and horror
39. Postpartum PTSD: Perception of lack of caring
Feeling abandoned Poor communication Feel invisible Feeling powerless The ends justify the means (healthy baby = happy mom) Avoidance of aftercare Impaired infant bonding PTSD in partner Sexual dysfunction Avoidance of future pregnancies Symptoms exacerbated in future pregnancies Elective C- sections
40. Risk factors for PTSD after birth: Neonatal complications
Lower gestational age
10 / 37 Imposter"
44. WHIPLASHED: Bipolar Depression
Wired or Worse on antidepressants Hypomania or mood swings, may only last a day or two Irritability, hostility, racing thoughts Psychomotor retardation Loaded family history, mood swings, bipolar, mood disorder and alcoholism Abrupt onset or ending of depressive (less than 2-3 months) or bursts of energy or mild hypomania before depression Seasonal or postpartum, SAD or hypomanic in spring Hypersomnia and overeating more common in BPD than unipolar Delusions, hallucinations, and other psychotic features more common than unipolar
45. Psychosis Prevalence: 1-2 in 1,000 postpartum women will develop psychosis
5% suicide 4.5% infanticide 50% of 1st time moms with psychosis had no previous psych hospitalization Onset usually within first 2 weeks after delivery
46. Postpartum Psychosis Symptoms: Delusions
Hallucinations Insomnia Confusion/disorientation Rapid mood swings Waxing and waning (feeling normal for periods of time) Ego Syntonic = wants to harm
47. Psychosis Risk Factors: History of Bipolar = HUGE risk for developing PPP 20-
30% of bipolar women will get psychosis 45-52% of stable bipolar women experience relapse or exacerbated symptoms during pregnancy 70% of women with bipolar will relapse within the first 6 months of postpartum First babies
11 / 37 Discontinuing mood stabilizers OB complications Perinatal infant mortality Previous bipolar episodes or psychosis Family history of bipolar Sleep deprivation
48. Postpartum Psychosis Prevention: Remain on medication
Immediate treatment postpartum Good sleep Symptoms wax and wane
49. OCD vs Psychosis: OCD =
- Recognizes thoughts are unhealthy
- Extreme anxiety related to thoughts
- Overly concerned about becoming "crazy"
- Ego-dystonic
- Does not want to hurt the baby (low risk) Psychosis=
- Do not recognize actions/thoughts are unhealthy
- May seem to have less anxiety when indulging in thoughts/behaviors
- Ego-syntonic (high risk)
50. Risk Factors Partner Depression: Feeling burdened or trapped
Financial responsibility Feeling outside the circle of attention Missing sexual relationship Sleep deprivation Isolation and loneliness
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- Atonement to infant after traumatic birth
- Healing mentally Impeding Nursing:
- Intruding flashbacks
- Detachment from infant
- Physical pain
- Feeling violated
- Insufficient milk supply
56. PADS: Post Adoption Depression Syndrome
A depressive state of the adoptive parent after placement of the new child into their home Most often affects adoptive mothers but is also common in fathers and occasionally in siblings Can affect all adoptive parents but most prevalent in those adopting older or post-institutionalized children.
57. Causes of PADS: Pre-adoptive expectations
LACK of hormonal response Child's post-adoption attachment issues Integration of an individual into the family dynamics Added burden of financial stress Unknowns Unresolved grief Tendency to suffer in silence
58. Neonatal Loss: About 20% of pregnancies end in loss
Anxiety more common than depression At risk for: PTSD OCD Anxiety
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59. NICU Families: Stress associated with perception of severity of infant's illness
Levels of depression related to mother's perception of nursing support
60. NICU Dads: Elevated and persistent levels of stress
61. Parents of Multiples: 43% greater risk of developing PPD
62. Teen Parents: About half of adolescent mothers feel depressed postpartum
These feelings last longer in teens (after 4 years PP)
63. Predictive Factors for PPD in Adolescent Mothers: Untreated depression in their mom Social
isolation Weight/shape disturbance Low maternal self efficacy Family conflict Low self-esteem History of abuse is related to severity of depression More likely to become pregnant again if stressed or depressed
64. Effects of PMDS on Teens: Decreased quality of life
Interference with developmental tasks of adolescence Stresses relationship with parents Decreased maternal role functioning Disrupts school and work plans
16 / 37 interventions Founder = Aaron Beck Teaches clients to identify, evaluate and change dysfunctional patterns of thinking, resulting in changes of mood and behavior Ettective treatment for depression, panic, anxiety, and OCD
71. IPT in Pregnancy for Prevention of PPD: Interpersonal Therapy
Reduction in likelihood of developing depression postpartum in high risk women Sessions held following routine childbirth education classes Focus on topics including managing role transition, identifying and establishing support systems, and improving communication
72. Sleep Hygiene: No electronics 20-60 mins before bed
Use bed only for sex and sleep, go to bed when sleepy Avoid alcohol, catteine, and nicotine in the hours before bedtime Warm bath/shower, pre-bed ritual If medication is used, take 45-60 mins prior to bed Eat a small protein snack before bed Create a dark, comfortable, and peaceful sleep environment Are there kids or pets in the bed that disturb sleep?
73. Why Screen?: Postpartum depression is not often recognized
PMADs remains underdiagnosed Can greatly reduce the duration and severity of symptoms Crucial for early detection and treatment Opportunities for discussion Reduces the stigma for mothers Early detection can greatly reduce the duration and severity of symptoms Screening tools are NOT diagnostic Does not take the place of clinical judgement Women with positive screens should be referred to a mental health professional
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74. Who Should Screen?: All healthcare professionals that have contact with pregnant or postpartum women
OB/GYN
Pediatricians Nurses, Midwives, social workers Home visitors WIC programs Hospitals Childbirth educators Lactation consultants
75. PDPI: Prenatal screening tool
Postpartum Depression Predictors Inventory Checklist to identify women at high risk for developing PPD Used during a clinician directed assessment NOT a self report questionnaire Detects areas where interventions can be initiated Measures self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy. Ideally, this checklist should be completed each trimester to update a pregnant woman's risk status.
76. Recommendations for Screening: First prenatal visit At
least once in second trimester At least once in third trimester Six weeks postpartum OB visit (1st postpartum visit) Repeated screenings at 6 and/or 12 months in OB and primary care settings 3,9, and 12 month pediatric visits
77. EPDS: Edinburgh Postnatal Depression Scale
Can be used during pregnancy Most thoroughly validated Cost ettective (free) Designed for postpartum use Validated
19 / 37 Disadvantages: Few studies have tested the PDSS as compared to the EPDS Must be purchased
81. PHQ: Patient Health Questionnaire (PHQ-9)
9 self report questions Advantages: Easy to score and linked with DSM-IV criteria Validated for prenatal use Useful for broad range of patients Developed for Family Practitioners Disadvantage: Not specific to perinatal patients
82. Screening and Bipolar Disorder: Women who score higher than 10 on the EPDS had a diagnosis of
BD
Women with treatment resistant postpartum depression actually sutter from BD
83. MDQ: Mood Disorder
Questionnaire Screen for mania or hypomania positive if 7 or more of 13 items in question #1 present and #2 is yes and #3 gets moderate or serious problem response Mood Disorder Questionnaire Easy SCREENING tool for detecting bipolar I or disorder. NOTE: It is NOT used for monitoring for improvement. Screen for mania or hypomania
84. Barriers to screening: Lack of
time Expense Lack of reimbursement for screening Fear of medical liability Providers unsure about appropriate treatments Lack of awareness of tools
85. Suicide Risk: Ideation: frequency, intensity, duration
Plan: timing, location, lethality availability, prepatory acts
20 / 37 Behaviors: past attempts, aborted attempts, vs. non self injurious acts Intent: extent to which the patent expects to carry out the plan and believes the plan/act to be lethal vs. self-injurious Explore ambivalence: reasons to die vs. reasons to live
86. Types of social support: Family and friends
Telephone Email and online Peer groups Faith communities Material or Practical Emotional Informational Comparison support (been there, know how you feel)
87. Self-help groups: The knowledge base of self-help mutual support groups is experiential, indigenous, and rooted
in the wisdom that comes from struggling with problems in concrete, shared ways Self-help groups build on the strengths of their members
88. Postpartum Support Groups: A psychoeducational group for women with low postpartum mood can
significantly reduce depressive symptoms A program of supportive group therapy for postpartum mothers can significantly lower or eliminate depressive episodes
89. Support Groups vs Therapy Groups: Support Groups:
Facilitator guides process and intervenes when needed Mothers support each other, give feedback or suggestions when asked Usually opens at all times to new members Support persons might be included Therapy Groups: Facilitator is a professional mental health provider More focus on group dynamics and therapeutic process for each woman Closed group for specific time period. Starts and ends Might include group for couples therapy
