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PSI Perinatal Mental Health Certification Exam
1. Theories of etiology: biological sensitivities to hormone changes (sleep), genetic vulnerability (prior diagnosis),
psychological (identity), social/environmental (poor social support/racism)
2. Baby Blues: Attects 60-80% new mothers. Due to hormone changes and sleep deprivation. lasts 2 days to 2 weeks.
Tearful, labile attect, reactivity, exhaustion BUT predominately happy, self-esteem remains unchanged. Resolves without intervention. Recommend self care strategies.
3. How to determine is it blues or depression: severity, intensity, duration of symptoms
4. Prevalence of postpartum anxiety: 8-20%
5. Prevalence of prenatal anxiety: 15%
6. Prevalence of postpartum depression: 21%
7. Prevalence of postpartum panic disorder: 11%
8. Prevalence of postpartum OCD: 11%
9. Prevalence of postpartum PTSD: 9%
10. Percentage of bipolar symptoms that relapse w/o meds: 70%
11. Prevalence of postpartum psychosis: 1-2 out of 1,
12. Prevalence of PPD in fathers: 10%
13. Prevalence psychosis in women with known bipolar disorder: 20-30%
14. Traits of OCD: 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.
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15. Traits of psychosis: 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
16. Traits of PTSD: intrusive thoughts (flashbacks), avoidance, negative cognitions and mood, arousal (sleep
disturbance, poor concentration, aggression, hyper vigilance)
17. maternal mortality-all women: 1,200 a year or 14.4 per 100,
18. maternal mortality-black women: 43.5 per 100,
19. Bipolar 1 Disorder: a type of bipolar disorder marked by at least one lifetime full manic and major
depressive episodes
20. Hypomania: A mild manic state in which the individual seems infectiously merry, extremely talkative, charming,
and tireless. up to 4 days in length
21. mania: a mood disorder marked by a hyperactive, wildly optimistic state-function is impaired. can last 7 days
22. prevalence of first diagnosis of bipolar disorder postpartum: 50%
23. Risk factors for postpartum psychosis: History of bipolar or psychotic disorder, first pregnancy, family
history, recent discontinuation of psychotropic medication
24. Postpartum psychosis symptoms: onset-2 weeks postpartum, poor concentration, disorien-tation,
agitation, aloof, lack of self care, elated/labile mood, rambling speech, thought broadcasting/delusion of grandiosity, disorganized thoughts, flight of ideas, hallucinations
25. reducing risk of postpartum psychosis: stay on bipolar medication, treat immediately in women
with history of psychosis and bipolar, good sleep is essential
26. Evidence based risk factors for PMADS: previous PMADS (family history, personal history, symptoms
during pregnancy), history of mood/anxiety disorders (personal or family history of depression, anxiety, OCD, eating disorders, bipolar
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37. NICU moms rate of depression: up to 63%
38. NICU moms rate of anxiety: up to 27%
39. NICU moms rate of PTSD: 53%
40. NICU dads: 30% screen positive for depressive symptoms
41. Risk of PTSD in NICU: related to parent's baseline coping and not size/sickness of baby
42. Moms who lost a pregnancy increased risk for: PTSD, OCD, anxiety
43. Timing of pregnancy losses: 80% first three months, 14% second tri, 6% third tri
44. Neonatal mortality rate: 3.9 per 1,
births congenital abnormalities account for 20% of deaths
45. leading causes of infant death: congenital abnormalities, preterm/low birth weight, SIDS, mater-nal
pregnancy complications, injuries
46. Infertility Stats: 1 in 8 couples
1/3 each maternal/paternal/unknown problem
47. Multiplies stats: 33.3 of 1000 births are twins, parents experience heightened symptoms of depression, anxiety
and parenting stress
48. PADS: post adoption depression syndrome. can attect all adoptive mothers, but higher in adoption of older children and
those coming from institutions.
49. American Academy of Pediatrics on breastfeeding: 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
50. Breastfeeding and depression relationship: bi-directional relationship. Breastfeeding may support
5 / 14 maternal mental health, exclusively breastfeeding may be less likely to be depressed, depression leads to lower breastfeeding rates and earlier cessation.
51. Hormones of lactation: prolactin and oxytocin
52. Galactagogue: Increases breast milk production
53. Reglan: Metoclopramide, increased risk of depression
54. medical conditions that decrease milk supply: thyroid dysfunction, anemia
55. breast feeding and depression: prenatal PMADS more likely to stop breastfeeding before 6 months,
weaning is associated with increased anxiety and depression, prenatal PMADS moms suttered greater anxiety and depression following cessation than non attected moms.
56. birth trauma and lactation themes supporting breastfeeding: proving oneself as a
mother, atonement to infant after traumatic birth, healing mentally
57. birth trauma and lactation themes impeding breastfeeding: flashbacks, detach-ment
from infant, physical pain, feeling violated, insuflcient milk supply
58. mothers who were medicated for depression breast fed longer than moms with
untreated depression:
59. Breastfeeding and race: gap between white and POC who breastfeed shrunk to 16% in 2008. Black infants
had lowest rates of breastfeeding initiation and duration.
60. POC higher rates of PMADS and birth trauma and lower rates of breastfeed-ing:
61. medical risks for teenage mothers: high blood pressure anemia, nutritional deficiencies, early labor, preterm
labor, low birth weight, STDs, higher rate of infant mortality, obstructed labor
62. predictive factors for PMADS in adolescent mothers: untreated depression in their mothers,
social isolation/peer rejection, weight/shape disturbance, low maternal self-eflcacy, family conflict, low self-esteem
7 / 14 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
70. underdiagnosed bipolar disorder: 22% of women who screen positive n EPDS at >10 had bipolar. 50%
of women with treatment resistant postpartum depression actually suttered from Bipolar disorder 1
71. Mood Disorder Questionnaire (MDQ): Screens for Bipolar Disorder
MDQ plus EPDS improved the distrinctionof unipolar depression from bipolar depression at the level of screening in 50% of women.
72. ACE: Adverse Childhood
Experiences abuse, neglect, house hold dysfunction
73. Culture: the enduring behaviors, ideas, attitudes, and traditions shared by a large group of people and transmitted
from one generation to the next
74. cultural humility: an interpersonal stance that is other-oriented rather than self-focused, characterized by
respect and lack of superiority toward an individual's cultural background and life experience
75. trauma informed care: involves viewing through an ecological and cultural lens and recognizing that context
plays a significant role in how individuals perceive and process traumatic events, whether acute or chronic.k involves anticipating and avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma, and it upholds the importance of consumer participation in the development, delivery and evaluation of services
76. Trauma-informed approach: realizes the prevalence of trauma and taking a universal precautions
position recognizes how trauma attects all individuals involved with the program, organization, or system, including its own workforce responds by putting this knowledge into practice resists re- traumatization
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77. social support: the perception that one has assistance available, the actual received assistance, or the degree to
which a person is integrated in a social network.
78. steps to develop a network: 1. brainstorming
2. investigation
3. planning
4. implementation
5. evaluation
6. future endeavors
79. 9 steps to wellness-Jane Honikman: a model of social support and guidance and intervention
1. education
2. sleep/rest
3. nutrition
4. exercise and time for self
5. sharing with non-judgmental listeners
6. emotional support
7. practical support
8. finding supportive resources
9. plan of action
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88. CBT for OCD: relabel, reattribute, refocus, revalue
89. relabel: notice and name the thoughts, it's just a thought
90. reattribute/reframe: increase awareness of cognitive distortions, examine the evidence
91. refocus: shift attention away from the worry/fear, refocus behavior on a pleasurable activity in the moment
92. revalue: thoughts do not equal actions, just a thought, show self compassion and positive self talk
93. interpersonal therapy (IPT): modifies disrupted relationships or expectations. Is based in attach-ment
theory, validated, time limited therapy, 12-16 weeks, IPT-P for perinatal depression, goal of treatment is symptom relief and reintegration
94. IPT strategies: teach communications skills (improve communication to get one's needs met), develop-ment a
social support network, role-playing, conjoint sessions
95. IPT target areas: 1.grief-what have I lost
loss of old role, poor adaptation to new role, rejection of new life. identify feelings and normalize experiences
2. where am I now
identify psychosocial and psychological changes, acquire new coping skills, develop new attachment and social support networks
3. what do I need
interpersonal role disputes. modify communication, reevaluate expectations in relationship, ettectively communicate needs to others.
96. IPT-P: initial phase: diagnose, conduct a formal interpersonal inventory-social, financial, emotional identify
target areas, set treatment goals middle phase-interpersonal skill development, new emotional equilibrium, encourage attective communication, identify losses, identify conflicts in maternal role,
11 / 14 final phase-termination, discuss end of treatment, aflrm all that has been learned, reinforce independent competence in recognizing and overcoming depression.
97. attachment and infant mental health: how baby is emotionally and physically attached to their caregiver,
caregiver helps to regulate the baby's response to threat/anxiety, if caregiver is depressed or disregulated, they may not be able to meet the baby's emotional needs in a consistent way-poor infant development
98. types of attachment: secure-baby uses parent as secure base, can be soothed, can be independent insecure-
avoidant, ambivalent, disorganized
99. prevalence of attachment types: 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
100. Infant Mental Health: "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."
101. promoting positive attachment: support and intervention,
assessing disruption in bonding and attachment evidence based approaches to facilitate secure attachments.
102. Impact of poor bonding and attachment: dysregulated sensitivity and responses, mother self
criticism, avoidance of connection, anxious mothering, isolation from social support
103. couples therapy: partner support has measurable ettect ott PMADS
marital disharmony is most commonly cited non-biological "cause" of PMADS, promote ettective communication, understanding and support between partners.
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114. Paroxitine (SSRI):
Paxil starting dose 10 mg range 20- 40mg short half life noticeable withdrawal ettects if missed dose
115. Fluoxitine (SSRI):
Prozac starting dose 10 mg range 20- 80mg longest half life minimal withdrawal ettect if missed dose
116. SNRI: serotonin norepinephrine reuptake inhibitor
117. Duloxetine (SNRI): Cymbalta
little safety data on use in pregnancy and lactation
118. Venlafaxine (SNRI): Ettexor
start dose 25 mg range 75-300mg short half life most safety data for pregnancy/lactation in SNRI class
119. Desvenlafaxine (SNRI): Pristiq
120. bupropion: Wellbutrin
augmentation for partial response to SSRI
121. Mirtazapine (Remeron): Atypical antidepressant: Can also be used as sleep aid and
for hyperemesis gravidarum
122. Vortiozetine: trintellix- new medication, don't start in pregnancy/postpartum, but don't stop is already stable
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123. tricyclic antidepressants-definition: 3rd line. only consider after failing multiple SSRI and SNRIs
124. Anxiolytics: Drugs that alleviate the symptoms of anxiety.
125. Buspirone (Buspar) non-benzo anxiolytics: Antianxiety
126. hydroxyzine (non-benzo anxiolytics): Vistaril
127. Quetlapine (Seroquel) non-benzo anxiolytics: atypical antipsychotic
128. Anxiolytics: Benzodiazepines: Treat: anxiety, mangement and chronic alcohol withdrawal syn-dromes.
xanax, klonopin, Ativan
129. SSRIs: Zoloft, celexa, lexapro, Paxil, prozac
130. SNRIs: Cymbalta, Ettexor, Pristiq
131. Atypical Antidepressants: Wellbutrin, remeron, trintellix
132. tricyclic antidepressants: norpramin, pamelor, elavil
133. Non-benzodiazepine used as an anxiolytic: buspar, vistril, Seroquel
134. Benzodiazepines: xanax, klonapin, Ativan
135. brexanolone-zulresso: medication for moderate to severe PPD. IV dose, inpatient stay, usually symp-toms
reduced within 24 hours.
