Pre and post natal

Question 1

What percent of pregnant women will meet criteria for a MDE during pregnancy?

Answer 1

14-23%

Question 2

What percent of women have some symptoms of a MDE postpartum?

Answer 2

50%

Question 3

What percent of women have some type of mood disturbance postpartum?

Answer 3

85%

Question 4

True or false: antenatal or postpartum depression increases the likelihood of a later MDE

Answer 4

True

Question 5

More or less education is a risk factor for postpartum depression?

Answer 5

Less

Question 6

Increased or decreased physical symptoms with pregnancy is a risk factor for postpartum depression?

Answer 6

Increased

Question 7

True or false: a distant h/o depression is a risk factor for postpartum depression

Answer 7

True

Question 8

What are the “baby blues”?

Answer 8

Mood disorder that presents within the first few days after delivery, and usually resolves within 2 weeks

Question 9

What is the incidence of baby blues?

Answer 9

50-85% of women

Question 10

What are the s/sx of baby blues? (4)

Answer 10

• Mood lability
• Tearfulness
• Anxiety
• Irritability

Question 11

What is the duration of baby blues?

Answer 11

Peak on 4th-5th day, and last from a few hours, to a few days

Question 12

True or false: the baby blues in and of themselves are not a disorder

Answer 12

True

Question 13

When is evaluation for baby blues needed?

Answer 13

If longer than 2 weeks

Question 14

When does postpartum depression begin?

Answer 14

Usually emerges 2-3 months postpartum, but must occur within 4 weeks of delivery

Question 15

True or false: postpartum depression is clinically indistinguishable from depression at other times

Answer 15

True

Question 16

What is the depression scale for postpartum depression?

Answer 16

Edinburgh postnatal depression scale

Question 17

What is the correlation between serum levels of hormones with postpartum depression?

Answer 17

There is none

Question 18

True or false: postpartum anxiety is equally common as postpartum depression

Answer 18

True

Question 19

What are the anxiety disorders that can appear postpartum? (4)

Answer 19

• GAD (adequacy of parenting)
• Panic attacks
• Hypochondriasis
• OCD (thoughts of harming baby)

Question 20

Who in particular is worried about parenting skills?

Answer 20

Those who had bad childhood experiences with their parents

Question 21

Why are panic attacks more common during pregnancy? (2)

Answer 21

• Hotter than usual during pregnancy–may predispose to panic attacks
• Baby kicks and hyperfocus on body

Question 22

What is the common presentation of OCD in new mothers?

Answer 22

Involves thoughts of harming the baby

Question 23

True or false: excessive thoughts of harming a baby in the postpartum period is common

Answer 23

True

Question 24

What is postpartum psychosis?

Answer 24

Typically a mixed or manic episode as part of a bipolar illness

Question 25

When do s/sx of postpartum psychosis usually begin?

Answer 25

2-3 days or within 2 weeks

Question 26

What percent of women who develop postpartum psychosis have no psych history?

Answer 26

50%

Question 27

What are the three major initial symptoms of postpartum psychosis?

Answer 27

- Restlessness - Irritability - Insomnia

Question 28

What are the later s/sx of symptoms of postpartum psychosis? (4)

Answer 28

- Rapidly confusing or shifting depressed or elated mood - Confusion - Erratic behavior - Delusions or hallucinations

Question 29

What is the major concern with postpartum psychosis?

Answer 29

Risks for suicide and infanticide are high

Question 30

What four things must be judged to assess for postpartum psychosis?

Answer 30

- Judgement - Reality testing - Anger control - Intent

Question 31

What is the way to talk about the thoughts of harming infants (if not psychotic)?

Answer 31

- High stress--normal | - "Thoughts are not behavior"

Question 32

What are the risks to the baby of untreated depression during pregnancy?

Answer 32

- Preterm - Low birth weight - SMGA

Question 33

What is the best predictor of long term neurocognitive outcomes with maternal depression?

Answer 33

Maternal mood--not medication exposure

Question 34

What are the primary treatments for intrapartum depression? (2)

Answer 34

- Interpersonal psychotherapy | - CBT

Question 35

What is the pharmacotherapy for intrapartum depression?

Answer 35

SSRIs

Question 36

True or false: medication risks are similar to untreated depression during pregnancy

Answer 36

True

Question 37

What are the fetal abnormalities with SSRIs?

Answer 37

Septal heart defects

Question 38

True or false: there is an elevated risk of miscarriage with SSRIs

Answer 38

True?

Question 39

True or false: there is not a risk of preterm birth with SSRIs intrapartum

Answer 39

False

Question 40

What is the SSRI of choice for pregnant women? Which is contraindicated?

Answer 40

- Sertraline is good | - Paroxetine is bad

Question 41

What is the role of SNRIs in pregnancy?

Answer 41

Not used, but not studied enough

Question 42

What are the s/sx of the SSRI use in the neonate? (6)

Answer 42

- Restlessness - Tremor - Rigidity - Tachypnea - Hypoglycemia - Szs

Question 43

What is the treatment for pregnant women with mild to moderate depression?

Answer 43

Therapy

Question 44

What is the treatment for pregnant women with severe depression?

Answer 44

Meds

Question 45

What is the treatment for pregnant women with bipolar disorder?

Answer 45

Medications--really need to control it

Question 46

What should be done with pregnancy if a woman is already on an SSRI? Why?

Answer 46

Take their preference into account -6x increase in depression relapse if taken off

Question 47

If a woman is on an SSRI that is not recommended in pregnancy, should she switch to one that is more studied in pregnancy?

Answer 47

No--leads to possible increased switching. Unless she asks to change

Question 48

What are the bipolar drugs that have a high risk of teratogenic effects?

Answer 48

Tegretol (carbamazepine) and depakote (valproic acid)

Question 49

What is the safest bipolar drug in pregnancy?

Answer 49

Li

Question 50

What is the major risk of valproic acid in pregnancy?

Answer 50

autism or congenital malformations (ASDs, cleft palate)

Question 51

What are the risks of untreated postpartum depression? (3)

Answer 51

- Less mother-child bonding - Poorer mental and motor development at 1 yr - Insecurity / behavioral disturbance

Question 52

What are the most common complications in modern obstetrics?

Answer 52

Postpartum depression

Question 53

Why are depressive symptoms common postpartum?

Answer 53

Very high expectations and demands

Question 54

The safest medication to treat depression while breastfeeding is what?

Answer 54

Whatever medication is likely to get the woman well

Question 55

True or false: postpartum depression is highly resistant to treatment

Answer 55

False

Question 56

Why is postpartum depression / anxiety underreported?

Answer 56

Shame around being depressed, or anxious thoughts