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What is a PMAD? - ANSWER- A perinatal mood and anxiety disorder (not just PPD!)
Define the perinatal period. - ANSWER- Time from conception through 1st year after giving
birth.
Define the prenatal or antenatal time - ANSWER- During pregnancy
Define the postpartum or postnatal time - ANSWER- 1st year after giving birth
What does PMAD mean? - 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? - ANSWER- 400,000...making
perinatal depression the most under diagnosed obstetric complication in America
PMADs can affect... - ANSWER- Anyone!
They do not discriminate. Can affect anyone. Socioeconomic status is NOT protective
_ in _ women are affected by perinatal depression - ANSWER- 1 in 7 women
Percentage of pregnancy induced HTN vs pre-eclampsia vs gestational diabetes vs PMADs? -
ANSWER- 6-8% PIH, 6-8% pre-eclampsia, 6% gestational diabetes, 21% PMADs
,_ in _ men are affected by perinatal depression - ANSWER- 1 in 10 men
Risks of untreated PMADs - 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? - ANSWER- 50%
Not all pregnancies are planned, wanted. Not all pregnancies end with a health baby or
fulfillment.
Etiology of PPD? - 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 - ANSWER- -in some cultures mothers may not feel safe to
express needs or seek help.
-may report symptoms differently based on culture
What did the landmark study on PPD show? - 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 - 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 - 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? - ANSWER- 10%
Depression in men: timing, symptoms - 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? - ANSWER- Not often. Only 3% sought help.
Men are likely to under report symptoms
Single mothers vs single fathers - 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 - ANSWER- Needs research to determine prevalence. Baseline
depression and anxiety higher than adult average already.
, Other people at risk - ANSWER- Non-gestational parents also at risk for PMADs.
Pregnancy VS Depression - 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 - 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 - 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
Major unipolar depression with peripartum onset DSM criteria - ANSWER- 5 or more symptoms
present for at least 2 weeks
Depressed mood most of day