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A comprehensive overview of the key topics and questions covered in the 2024 psi perinatal mental health certification exam. It covers a wide range of subjects related to perinatal mental health, including the prevalence of various conditions, risk factors, symptoms, treatment options, and the impact on infant development. The document delves into the theories of etiology, diagnostic criteria, and evidence-based practices for managing perinatal mood and anxiety disorders (pmads). It also addresses the unique challenges faced by specific populations, such as single parents, nicu parents, and those who have experienced pregnancy loss. The information presented is highly relevant for healthcare professionals, researchers, and students interested in the field of perinatal mental health.
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Theories of etiology - correct answers ✅biological sensitivities to hormone changes (sleep), genetic vulnerability (prior diagnosis), psychological (identity), social/environmental (poor social support/racism) Baby Blues - correct answers ✅Affects 60-80% new mothers. Due to hormone changes and sleep deprivation. lasts 2 days to 2 weeks. Tearful, labile affect, reactivity, exhaustion BUT predominately happy, self-esteem remains unchanged. Resolves without intervention. Recommend self care strategies. How to determine is it blues or depression - correct answers ✅severity, intensity, duration of symptoms Prevalence of postpartum anxiety - correct answers ✅8- 20% Prevalence of prenatal anxiety - correct answers ✅15% Prevalence of postpartum depression - correct answers ✅21% Prevalence of postpartum panic disorder - correct answers ✅11%
Prevalence of postpartum OCD - correct answers ✅11% Prevalence of postpartum PTSD - correct answers ✅9% Percentage of bipolar symptoms that relapse w/o meds - correct answers ✅70% Prevalence of postpartum psychosis - correct answers ✅1-2 out of 1, Prevalence of PPD in fathers - correct answers ✅10% Prevalence psychosis in women with known bipolar disorder - correct answers ✅20-30% Traits of OCD - correct answers ✅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. Traits of psychosis - correct answers ✅does not recognize actions/thoughts are unhealthy, may seem to
mania - correct answers ✅a mood disorder marked by a hyperactive, wildly optimistic state-function is impaired. can last 7 days prevalence of first diagnosis of bipolar disorder postpartum - correct answers ✅50% Risk factors for postpartum psychosis - correct answers ✅History of bipolar or psychotic disorder, first pregnancy, family history, recent discontinuation of psychotropic medication Postpartum psychosis symptoms - correct answers ✅onset-2 weeks postpartum, poor concentration, disorientation, agitation, aloof, lack of self care, elated/labile mood, rambling speech, thought broadcasting/delusion of grandiosity, disorganized thoughts, flight of ideas, hallucinations reducing risk of postpartum psychosis - correct answers ✅stay on bipolar medication, treat immediately in women with history of psychosis and bipolar, good sleep is essential Evidence based risk factors for PMADS - correct answers ✅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 disorders), significant mood reactions of hormonal changes (puberty, PMS, hormonal birth control) More evidence based risk factors for PMADS - correct answers ✅endocrine dysfunction (diabetes, thyroid imbalance, fertility challenges), social factors (IPV, low support, financial stress, racism), high stress parenting (military families, adolescent parents, parents of multiples, single parents) Exacerbating factors of postpartum depression - correct answers ✅pain, lack of sleep, abrupt discontinuing of breast feeding, childcare stress, relationship stress, losses, history of childhood sexual abuse, complicated pregnancy, health changes in baby or parents, temperament of baby, climate stressors: seasonal depression or mania, perfectionism/high expectations, unresolved grief or attachment with mother, returning to work Substance Use in Pregnancy - correct answers ✅5.4% all women use illicit drugs during pregnancy, 14.6% of adolescent moms
feeding issues, increased frequency of GI upset, prone to colic, excessive crying, irritability. NICU family prevalence of PMADS - correct answers ✅20- 30% of diagnosable mental health disorder. more experience PTSD NICU moms rate of depression - correct answers ✅up to 63% NICU moms rate of anxiety - correct answers ✅up to 27% NICU moms rate of PTSD - correct answers ✅53% NICU dads - correct answers ✅30% screen positive for depressive symptoms Risk of PTSD in NICU - correct answers ✅related to parent's baseline coping and not size/sickness of baby Moms who lost a pregnancy increased risk for - correct answers ✅PTSD, OCD, anxiety
Timing of pregnancy losses - correct answers ✅80% first three months, 14% second tri, 6% third tri Neonatal mortality rate - correct answers ✅3.9 per 1, births congenital abnormalities account for 20% of deaths leading causes of infant death - correct answers ✅congenital abnormalities, preterm/low birth weight, SIDS, maternal pregnancy complications, injuries Infertility Stats - correct answers ✅1 in 8 couples 1/3 each maternal/paternal/unknown problem Multiplies stats - correct answers ✅33.3 of 1000 births are twins, parents experience heightened symptoms of depression, anxiety and parenting stress PADS - correct answers ✅post adoption depression syndrome. can affect all adoptive mothers, but higher in adoption of older children and those coming from institutions. American Academy of Pediatrics on breastfeeding - correct answers ✅infants should be exclusively breast
with increased anxiety and depression, prenatal PMADS moms suffered greater anxiety and depression following cessation than non affected moms. birth trauma and lactation themes supporting breastfeeding - correct answers ✅proving oneself as a mother, atonement to infant after traumatic birth, healing mentally birth trauma and lactation themes impeding breastfeeding - correct answers ✅flashbacks, detachment from infant, physical pain, feeling violated, insufficient milk supply mothers who were medicated for depression breast fed longer than moms with untreated depression - correct answers ✅ Breastfeeding and race - correct answers ✅gap between white and POC who breastfeed shrunk to 16% in 2008. Black infants had lowest rates of breastfeeding initiation and duration. POC higher rates of PMADS and birth trauma and lower rates of breastfeeding - correct answers ✅
medical risks for teenage mothers - correct answers ✅high blood pressure anemia, nutritional deficiencies, early labor, preterm labor, low birth weight, STDs, higher rate of infant mortality, obstructed labor predictive factors for PMADS in adolescent mothers - correct answers ✅untreated depression in their mothers, social isolation/peer rejection, weight/shape disturbance, low maternal self-efficacy, family conflict, low self-esteem Teens and PMADS - correct answers ✅almost 1/ reported depressive symptoms, can last up to 4 years after birth. decreased quality of life, interference with developmental tasks of adolescence, stressed relationship with parents, friends and family, decreased maternal role functioning, disrupts school and work plans. most go untreated. Military PMAD risk - correct answers ✅deployment of spouse during entire pregancy associated with 3.4%increase in preterm delivery and 3 %increased risk for PPD 66% military spouses reported that seeking mental health support would hurt spouse's chance of promotion
used by health care providers, in validity is well established, particularly for identifying severe depression. validated for perinatal use, but not exclusively for that purpose Postpartum depression screening scale (PDSS) - correct answers ✅first 7 questions are short form. if >14, long form 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 underdiagnosed bipolar disorder - correct answers ✅22% of women who screen positive n EPDS at >10 had bipolar. 50% of women with treatment resistant postpartum depression actually suffered from Bipolar disorder 1 Mood Disorder Questionnaire (MDQ) - correct answers ✅Screens for Bipolar Disorder MDQ plus EPDS improved the distrinctionof unipolar depression from bipolar depression at the level of screening in 50% of women. ACE - correct answers ✅Adverse Childhood Experiences abuse, neglect, house hold dysfunction
Culture - correct answers ✅the enduring behaviors, ideas, attitudes, and traditions shared by a large group of people and transmitted from one generation to the next cultural humility - correct answers ✅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 trauma informed care - correct answers ✅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 Trauma-informed approach - correct answers ✅realizes the prevalence of trauma and taking a universal precautions position recognizes how trauma affects all individuals involved with the program, organization, or system, including its own workforce
change dysfunctional patterns of thinking, resulting in mood and behavioral changes a collaborative approach, relaxation training, education about CBT common CBT components - correct answers ✅assertiveness training, resiliency, cognitive restructuring, desensitization and exposure therapy cognitive restructuring - correct answers ✅a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs anxiety - correct answers ✅we overestimate the danger and underestimate our coping tools and ability to cope goals of CBT for anxiety - correct answers ✅reduce physical hyper vigilance, take away the danger, recognize anxiety as an alarm. increase perceived control and resilience, develop coping plans and skills, exposure to feared symptoms and situations trauma psychotherapy-CBT - correct answers ✅collaborative, educate, reconceptulaize the
IPT strategies - correct answers ✅teach communications skills (improve communication to get one's needs met), development a social support network, role-playing, conjoint sessions IPT target areas - correct answers ✅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
communication, identify losses, identify conflicts in maternal role, final phase-termination, discuss end of treatment, affirm all that has been learned, reinforce independent competence in recognizing and overcoming depression. attachment and infant mental health - correct answers ✅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 types of attachment - correct answers ✅secure-baby uses parent as secure base, can be soothed, can be independent insecure-avoidant, ambivalent, disorganized prevalence of attachment types - correct answers ✅secure-60-75% avoidant-15-25% ambivalent-10-15% disorganized-less than 14%