Perinatal Mental Health Exam
– Questions
with Complete Solutions
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 prenatalor antenataltime - (correctanswer)-During pregnancy
Define the postpartumor postnataltime - (correctanswer)-1st year aftergiving 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 affectanyone.Socioeconomicstatusis NOT protective
_ in _ womenare affectedby perinataldepression- (correctanswer)-1 in 7 women
Percentage of pregnancy induced HTN vs -eclampsia
pre vs gestational diabetes vs PMADs?
-
(correct answer)-6-8% PIH, 6-8% pre-eclampsia, 6% gestational diabetes, 21% PMADs
_ in _ men are affectedby perinataldepression- (correctanswer)-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 pregnanciesare unplanned?- (correctanswer)-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.
-may reportsymptomsdifferentlybasedon 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 thoughtsof harming selves
Prenatal depression relapse rate with meds and without -meds
(correct answer)-26% who continued
meds relapsed during pregnancy while 68% who stopped relapsed
meds
Higher relapserate if you DC meds
Percentof fatherswith PPD? - (correctanswer)-10%
Depression in men: timing, symptoms
- (correct answer)-Peaks at 3-6 monthspostpartum
May not be sad "masked" and irritable, aggressive, hostile, acting out, checked
distractions
out,
Do men seek help for their depression?
- (correct answer)-Not often. Only 3% sought
help.
Men are likely to under reportsymptoms
,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:have3 times mortalityrate than single mothersor partneredparents.
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
Lasts 2 days-2 weeks.Peaks3-5 d.
Symptoms of baby blues
- (correct answer)-Tearfulness, liability, exhaustion Predominately happy,
self esteem unchanged
Unrelatedto stressor prior psychhistory
Consider timing, onset, severity, duration, chronicity when differentiation between PPD and baby
blues
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
PsychomotoragitationFatigue
Poor focus Worthless
feelings Excessive guilty
, Recurrentthoughtsof death/suicide
perinatalanxietydisorders- (correctanswer)-Includes GAD, panic
GAD DSM-5 Criteria- (correct answer)-Excessive worry and anxiety (about ones own and babies
needs)
Difficulty controllingworry
Agitation, irritable Restless,
feeling on edge Poor
concentration
Fatigue,sleepdisturbance(insomnia)
Increased somatic symptoms
-muscle tension, palpitations, GI, SOB Prevalence of perinatal
anxiety- (correct answer)-15%
Estimatesbetween8-20%
Panic disorder dsm criteria
- (correct answer)-Episodes of intense fear peakingminutes
in
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 greatestfearsin panic disorder- (correctanswer)-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.
– Questions
with Complete Solutions
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 prenatalor antenataltime - (correctanswer)-During pregnancy
Define the postpartumor postnataltime - (correctanswer)-1st year aftergiving 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 affectanyone.Socioeconomicstatusis NOT protective
_ in _ womenare affectedby perinataldepression- (correctanswer)-1 in 7 women
Percentage of pregnancy induced HTN vs -eclampsia
pre vs gestational diabetes vs PMADs?
-
(correct answer)-6-8% PIH, 6-8% pre-eclampsia, 6% gestational diabetes, 21% PMADs
_ in _ men are affectedby perinataldepression- (correctanswer)-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 pregnanciesare unplanned?- (correctanswer)-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.
-may reportsymptomsdifferentlybasedon 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 thoughtsof harming selves
Prenatal depression relapse rate with meds and without -meds
(correct answer)-26% who continued
meds relapsed during pregnancy while 68% who stopped relapsed
meds
Higher relapserate if you DC meds
Percentof fatherswith PPD? - (correctanswer)-10%
Depression in men: timing, symptoms
- (correct answer)-Peaks at 3-6 monthspostpartum
May not be sad "masked" and irritable, aggressive, hostile, acting out, checked
distractions
out,
Do men seek help for their depression?
- (correct answer)-Not often. Only 3% sought
help.
Men are likely to under reportsymptoms
,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:have3 times mortalityrate than single mothersor partneredparents.
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
Lasts 2 days-2 weeks.Peaks3-5 d.
Symptoms of baby blues
- (correct answer)-Tearfulness, liability, exhaustion Predominately happy,
self esteem unchanged
Unrelatedto stressor prior psychhistory
Consider timing, onset, severity, duration, chronicity when differentiation between PPD and baby
blues
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
PsychomotoragitationFatigue
Poor focus Worthless
feelings Excessive guilty
, Recurrentthoughtsof death/suicide
perinatalanxietydisorders- (correctanswer)-Includes GAD, panic
GAD DSM-5 Criteria- (correct answer)-Excessive worry and anxiety (about ones own and babies
needs)
Difficulty controllingworry
Agitation, irritable Restless,
feeling on edge Poor
concentration
Fatigue,sleepdisturbance(insomnia)
Increased somatic symptoms
-muscle tension, palpitations, GI, SOB Prevalence of perinatal
anxiety- (correct answer)-15%
Estimatesbetween8-20%
Panic disorder dsm criteria
- (correct answer)-Episodes of intense fear peakingminutes
in
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 greatestfearsin panic disorder- (correctanswer)-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.
