PSI Diagnoses and Prevalence of PMADs

Question 1

PMAD

Answer 1

Perinatal Mood and Anxiety Disorders

Question 2

PMAD have an ______ risk in the perinatal period

Answer 2

increased

Question 3

what is the most under diagnosed obstetric complication in America?

Answer 3

perinatal depression

Question 4

Who is at risk for PMAD?

Answer 4

ANYONE
-they dont discriminate
-money and socioeconomics are not protective

Question 5

prevalence of PMADs in women?

Answer 5

1 in 5-7 women

Question 6

prevalence of PMADS in men?

Answer 6

1 in 10 men

Question 7

evidence based risk factors for PMADS:

Answer 7

-endocrine dysfunction
-significant mood reactions to hormonal changes
-lack of sleep
-family or personal hx of PMADS or psych disorders
-history of childhood sexual abuse

Question 8

In the landmark study of 10,000 US mothers, how many had depression in the first year postpartum?

Answer 8

21.9%

Question 9

when are fathers most vulnerable to post partum depression?

Answer 9

3-6 months postpartum

Question 10

What is are the big things that distinguish normal pregnancy vs depression?

Answer 10

1. Pregnancy: self esteem is unchanged, Depression: self esteem is low
2. Pregnancy: no issues falling asleep, Depression: difficulty initiating sleep
3. Pregnancy: can experience pleasure, Depression: anhedonia

Question 11

Difference between “Baby Blues” and PP Depression?

Answer 11

Baby blues lasts 2 days to 2 weeks, depression lasts longer than 2 weeks

Question 12

What diagnoses can the DSM specification “peripartum onset” be added on to?

Answer 12

-depression
-bipolar disorder

Question 13

What does the DSM specifier “peripartum” refer to?

Answer 13

depression in pregnancy or within 4 weeks following birth

Question 14

Depression DSM 5 criteria?

Answer 14

5 of SIGECAPS must be met with depressed mood

Question 15

GAD DSM 5 criteria:

Answer 15

3 or more of the following:
-excessive anxiety and worry
-difficulty controlling worry
-agitation/irritability
-restlessness, feeling on edge
-poor concentration
-poor sleep
-increased somatic sx (muscle tension, elevate HR, etc)

Question 16

Prevalence rate for prenatal/antenatal anxiety?

Answer 16

15.8%

Question 17

Prevalence of postpartum anxiety?

Answer 17

8-20%

Remember: can happen for dads too, tends to decrease in prevalence for men post partum

Question 18

Panic disorder DSM 5 criteria:

Answer 18

Four or more sx:
-intense fear reaching a peak in minutes
-shortness of breath, chest pain
-heart racing, numbness, hot flashes
-restlessness, agitation
excessive worry of fear
-fear of going crazy or losing control
-no identifiable trigger

Question 19

Three greatest fears associated with panic disorder?

Answer 19

fear of dying, going crazy, losing control

Question 20

Perinatal OCD prevalence rate?

Answer 20

-perinatal women 1.5 to 2x greater risk for OCD than general population
-perinatal onset 32%
-can have comorbid depression

Question 21

Difference between OCD and Psychosis?

Answer 21

-OCD thoughts are ego dystonic, compulsions are performed to avoid harm, minimize triggers
-psychotic thoughts may not be noticed by individual (poor insight), less anxiety and distress over these thoughts, delusional thinking, do not question following through with acting on the disturbing thoughts

Question 22

Gold standard treatment for OCD?

Answer 22

exposure and response prevention

Question 23

How to screen for OCD?

Answer 23

Providers must ask about scary or unusual thoughts

Question 24

A patient experiences traumatic event. How long must they experience symptoms for it to be considered PTSD?

Answer 24

at least 1 month

Question 25

Prevalence of Perinatal PTSD?

Answer 25

-prenatal 3.3% -postpartum 4%; 18.5% in high risk groups

Question 26

What is Birth Trauma?

Answer 26

event during labor and birth involving serious physical or moral injury or death

Question 27

How can you prepare for birth trauma?

Answer 27

Do a Delivery Coping Plan (trauma-informed birth planning activity)

Question 28

Who is more at risk for pregnancy related mortailty?

Answer 28

people of color, particularly black women (3.2 times higher in black women, 2.3 times higher in other POC)

Question 29

Black mothers are ___ times more likely to die from maternity related complications compared to white mothers.

Answer 29

4

Question 30

Of women screening positive for depression, how many actually have bipolar disorder?

Answer 30

22.6%

Question 31

Difference between mania and hypomania?

Answer 31

mania impairs functioning, hypomania improves funcitoning

Question 32

50 % of women with bipolar disorder are first diagnosed when?

Answer 32

postpartum

Question 33

What is the risk of relapse of bipolar 1 mood episode during pregnancy?

Answer 33

71%

Question 34

What is the risk of recurrence of bipolar 1 mood episode in women who stop mood stabilizers?

Answer 34

2x risk of recurrence, 4x times more rapidly than women on medication

Question 35

What is the risk of psychotic episode in women with bipolar 1?

Answer 35

20-30%

Question 36

What is the risk of relapse of bipolar mood episode during pregnancy?

Answer 36

45-52%

Question 37

When are women with bipolar disorder most succepitble to mood episode relapse during perinatal period?

Answer 37

70% relapse within the first 6 months post partum

Question 38

Prevalence of postpartum psychosis

Answer 38

1-2 out of every 1,000 women

Question 39

Risk factors for perinatal psychosis

Answer 39

-first baby -discontinuation of mood stabilizer -obstetric complications -perinatal/neonatal loss -previous bipolar or psychotic episodes -family hx of bipolar or postpartum, psychosis -sleep deprivation

Question 40

time period most vulnerable for postpartum psychosis

Answer 40

within 2 weeks postpartum

Question 41

how to reduce risk for postpartum psychosis

Answer 41

-women with Bipolar disorder should remain on mood stabilizer through pregnancy to prevent postpartum relapse -initiate treatment immediately post partum in women with history of postpartum psychosis only -good sleep

Question 42

risk of recurrence of psychotic episode in women with hx of PP psychosis after a subsequent pregnancy

Answer 42

29%

Question 43

percentage of women with hx of PP psychosis only who DID NOT have recurrence of psychotic symptoms outside of PP period:

Answer 43

43.5%

Question 44

in 2022, 204,000 pregnant women used drugs nationally. what is this percentage?

Answer 44

10%

Question 45

most common substances used in pregnancy?

Answer 45

alcohol, tobacco, cannabis

Question 46

presence of births associates with OUD have increased how many times?

Answer 46

4 times, from 1.5 in every 1000 to 6.5 in every 1000 deliveries

Question 47

substance use disorder is related to how many pregnancy-related maternal deaths?

Answer 47

25%