Perinatal Mood and Anxiety Disorders Overview
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Questions and Answers

What percentage of new fathers are likely to experience symptoms of postpartum depression or other perinatal mood disorders after childbirth?

  • 1 in 12
  • 1 in 7
  • 1 in 10 (correct)
  • 1 in 5

    • Which of the following conditions is recognized as a potential risk factor for perinatal mood and anxiety disorders?

  • Hypertension
  • Hyperthyroidism
  • Gestational diabetes (correct)
  • Preeclampsia

    • What is the time frame in which postpartum psychosis most commonly occurs?

  • After three months postpartum
  • Within the first month postpartum
  • After the first month but before three months
  • In the first two weeks postpartum (correct)

    • What is the primary mission of Postpartum Support International (PSI)?

    <p>To promote awareness, prevention, and treatment of mental health issues related to childbearing</p> Signup and view all the answers

    What percentage of postpartum depression cases are typically detected and diagnosed?

    <p>40%</p> Signup and view all the answers

    Which of the following describes a common barrier to screening for perinatal mood and anxiety disorders?

    <p>Provider doesn’t know where to send patients if they screen positive</p> Signup and view all the answers

    What does the acronym EPDS stand for?

    <p>Edinburgh Postnatal Depression Scale</p> Signup and view all the answers

    Who stated that 'trauma is in the eye of the beholder' in relation to birth trauma?

    <p>Cheryl Beck</p> Signup and view all the answers

    What is the increased risk factor for developing postpartum depression in women compared to the general population?

    <p>1.5-2x</p> Signup and view all the answers

    What percentage of women are estimated to experience perinatal mood and anxiety disorders during or after pregnancy?

    <p>15-20%</p> Signup and view all the answers

    What is the primary risk associated with mood stabilizers during pregnancy?

    <p>Malformations of the fetus</p> Signup and view all the answers

    What percentage of first-time mothers experiencing postpartum psychosis had no prior history of mental health issues?

    <p>50%</p> Signup and view all the answers

    What percentage of women who screened positive for postpartum depression are found to have bipolar disorder, according to recent findings?

    <p>22.6%</p> Signup and view all the answers

    Which of the following drugs is associated with low birth weight babies?

    <p>Nicotine</p> Signup and view all the answers

    What is the estimated annual economic burden associated with untreated perinatal mood and anxiety disorders?

    <p>$14.2 billion</p> Signup and view all the answers

    Which class of medications has been associated with an increased risk of low birth weight in infants when used during pregnancy?

    <p>Benzodiazepines</p> Signup and view all the answers

    What percentage of individuals with perinatal anxiety disorders also experience co-morbid depression?

    <p>65%</p> Signup and view all the answers

    Which endocrine condition is associated with an increased likelihood of developing perinatal mood and anxiety disorders?

    <p>PCOS</p> Signup and view all the answers

    What percentage of women relapse with bipolar disorder within the first 6 months postpartum?

    <p>70%</p> Signup and view all the answers

    What is the range of postpartum alcohol abuse among women?

    <p>40-49%</p> Signup and view all the answers

    Which class of medications is considered the most effective for treating atypical depression?

    <p>MAOIs</p> Signup and view all the answers

    Which risk factor is associated with stopping mood stabilizers?

    <p>4x faster recurrence</p> Signup and view all the answers

    What percentage of fetuses are reported to have a minor or major structural problem in development?

    <p>2-3%</p> Signup and view all the answers

    What are the neurotransmitters involved in atypical antidepressants?

    <p>Dopamine, Serotonin, Norepinephrine</p> Signup and view all the answers

    What percentage of women reports illicit drug use during pregnancy?

    <p>5%</p> Signup and view all the answers

    How much greater is the risk of postpartum drug use compared to the general population?

    <p>4.5-8.5%</p> Signup and view all the answers

    What is the estimated rate of postpartum PTSD criteria related to traumatic births?

    <p>34%</p> Signup and view all the answers

    What is a subsyndromal depression?

    <p>A brief recurrent depression episode</p> Signup and view all the answers

    What percentage of postpartum women develop perinatal psychosis and commit suicide?

    <p>5%</p> Signup and view all the answers

    What is the prevalence rate for new onset perinatal obsessive-compulsive disorder (OCD)?

    <p>30%</p> Signup and view all the answers

    Among the classic symptoms of perinatal OCD, which is the most common?

    <p>Fear of deliberate harm</p> Signup and view all the answers

    What is the prevalence of PTSD among pregnant women?

    <p>12%</p> Signup and view all the answers

    What percentage of women with bipolar disorder experience a relapse or exacerbation of symptoms during pregnancy?

    <p>45-52%</p> Signup and view all the answers

    What is the neonatal mortality rate defined as?

    <p>28 deaths per 1,000 live births</p> Signup and view all the answers

    What is the percentage of new mothers who experience symptoms of perinatal OCD?

    <p>11%</p> Signup and view all the answers

    What is the estimated percentage of women with bipolar disorder who were diagnosed during the postpartum period?

    <p>50%</p> Signup and view all the answers

    What percentage of NICU parents experience a diagnosable mental health disorder during the first postpartum year?

    <p>20-30%</p> Signup and view all the answers

    What is the death ratio to live births for women of other ethnic/racial groups?

    <p>14.4 deaths/100,000</p> Signup and view all the answers

    What percentage of women with bipolar disorder who stop medication during pregnancy will become ill?

    <p>70%</p> Signup and view all the answers

    What is the self-reported use of cannabis among postpartum women?

    <p>2-5%</p> Signup and view all the answers

    What hormones does depression suppress that are essential to lactation?

    <p>Prolactin and oxytocin</p> Signup and view all the answers

    What are the three greatest fears arising from panic disorder?

    <p>Dying, going crazy, and losing control</p> Signup and view all the answers

    What is the prevalence of postpartum anxiety symptoms reported?

    <p>8-20%</p> Signup and view all the answers

    What is an essential role of a professional in primary prevention?

    <p>Assessing risk</p> Signup and view all the answers

    What is the most common ‘cut-off’ score on the EPDS for a positive screen for postpartum depression?

    <p>10</p> Signup and view all the answers

    Which treatment approach is recognized as a non-traditional method that has been studied for its effects?

    <p>Bright light therapy</p> Signup and view all the answers

    What are three core areas of focus in Interpersonal Psychotherapy (IPT)?

    <p>Grief, role transitions, interpersonal disputes</p> Signup and view all the answers

    What is the chance that a father will also experience depression if the mother has postpartum depression?

    <p>50%</p> Signup and view all the answers

    What can the theory of 'psychosocial adaptation to motherhood' best be attributed to?

    <p>Lederman</p> Signup and view all the answers

    In postpartum psychosis, the acute form can be conceptualized as which of the following?

    <p>An acute manic episode</p> Signup and view all the answers

    Which term refers to the emotional dismissal of a pregnancy's significance?

    <p>Affective denial</p> Signup and view all the answers

    What are the four steps of Jeffrey Schwartz's Cognitive Behavioral Therapy for OCD symptoms?

    <p>Re-label, reattribute, refocus, revalue</p> Signup and view all the answers

    What is the term for when denial results in a misunderstanding or absence of pregnancy symptoms?

    <p>Pervasive denial</p> Signup and view all the answers

    What is the most accurate statement regarding SSRIs during pregnancy?

    <p>No adverse effects on fetal development have shown significant risk.</p> Signup and view all the answers

    What is a psychological risk factor for developing a perinatal mood disorder?

    <p>Unresolved losses</p> Signup and view all the answers

    Which factor indicates increased school readiness associated with a father’s involvement in the first year postpartum?

    <p>Increased school readiness</p> Signup and view all the answers

    What is the primary objective of the 2020 MOM initiative?

    <p>To close gaps in maternal mental healthcare by 2020</p> Signup and view all the answers

    Study Notes

    Perinatal Mood and Anxiety Disorders (PMADs)

    • Approximately 1 in 7 new mothers and 1 in 10 new fathers experience postpartum depression or other PMADs.
    • Trauma-informed care prioritizes adaptation, resilience, and recovery.
    • Prevalence rates for different PMADs:
      • Prenatal anxiety: 15%
      • Postpartum depression: 21%
      • Postpartum Panic Disorder: 11%
      • Postpartum OCD: 11%
      • Postpartum PTSD: 9%
      • Postpartum Psychosis: 1-2/1000
      • Psychosis in women with known bipolar disorder: 20-30%
    • Postpartum panic disorder symptoms: extreme anxiety, shortness of breath, chest pain, dizziness, hot flashes, trembling, rapid heart rate, numbness, restlessness, agitation, irritability, excessive worry, fear; peaks at 2 minutes, improves after 10 minutes; best treated with education.
    • Greatest fears in panic disorder: dying, going crazy, losing control.
    • Impact of PMADs: increased medical costs, inappropriate care, child abuse/neglect, breastfeeding cessation, family dysfunction, adverse early brain development.
    • Detection and treatment rates: 40% detected/diagnosed, 60% receive treatment.
    • Risk factors for PMADs: gestational diabetes, past trauma, ambivalence about maternal role, unresolved losses, unwanted pregnancy, infertility issues, sick/colicky infant.

    Specific PMADs - Prevalence and Risk Factors

    • Postpartum depression in the first 3 months: 1 in 7; first year: 1 in 5 (Wisner 2012).
    • Parents of multiples: 43% chance of PPD.
    • Risk factor for PMADs: PCOS.
    • Paternal PPD: associated with social/behavioral problems in boys, particularly at age 3.

    Treatment and Support for PMADs

    • Evidence-based screening tools: Edinburgh Postnatal Depression Scale (EPDS).
    • Common cut-off score for positive EPDS: 10
    • Non-traditional treatments: bright light therapy
    • Cognitive restructuring (CBT): Identify automatic thoughts, observe thought-feeling connection, identify cognitive distortions
    • Interpersonal Psychotherapy (IPT): Grief, role transitions, interpersonal disputes
    • Trauma psychotherapy: Collaborative therapeutic relationship, client's story, client's strengths and resilience.
    • Cognitive Behavioral Therapy for OCD (Jeffrey Schwartz): Re-label, Reattribute, Refocus, Revalue.
    • Psychosocial adaptation to motherhood: Lederman's theory, themes of life growth, primary relatedness, supportive matrix, and identity reorganization.

    Maternal Mental Health Considerations During Pregnancy & Postpartum

    • Pregnancy denial: Affective denial (dismissive emotional significance of pregnancy), pervasive denial (misconstruing/absence of pregnancy symptoms).
    • Neonaticide: Mother takes life of child within 24 hours of birth.
    • Postpartum psychosis: May be conceptualized as an acute manic episode
    • Interconception care: Planning and care between pregnancies

    Resilience, Prevention, and Healthcare Approach

    • Intergenerational transmission of resilience: Concept introduced in class to facilitate family resilience.
    • 2020 MOM: Initiative to close gaps in maternal mental healthcare
    • Maternal Mental Health Awareness week: Early May
    • PSI help line: 1-800-944-4PPD (for licensed medical professionals).
    • Community mobilization resources: Jane Honikman Postpartum Action Institute.
    • Research report: National Center for Children in Poverty report on maternal depression.

    Medication and Treatment Considerations during perinatal periods

    • Antidepressants in pregnancy: If on an antidepressant and have a history of chronic or relapsing depression or new onset severe depression.
    • SSRI and SNRI use in pregnancy: Studies have not shown birth defects in SSRI/SNRI usage.
    • Starting SSRI during pregnancy: Start at a low dose.
    • Breastfeeding and SSRIs: Not needed to change medication if successful during pregnancy.
    • ECT (Electroconvulsive Therapy): Safe in pregnancy and postpartum.
    • Medication after symptoms resolve: Continue medication for 1 year after a first episode of depression to prevent relapse.
    • Bipolar disorder during pregnancy and postpartum: Women who stop mood stabilizers have 2x higher risk of recurrence and 4x faster recurrence, 70% of women with bipolar disorder who stop medication when pregnant become ill during pregnancy, 71% relapse during pregnancy, treatment with medication throughout pregnancy is recommended for women with a hx of postpartum psychosis who desire a second pregnancy.
    • No significant increase in risk of autism/ADHD in fetuses exposed to SSRIs.
    • Medication categories: A (safe), B (use with caution), C (not recommended), D (human fetal risk, last resort), X (contraindicated).
    • MAOIs: Can cause hypertensive crisis.

    Other Important Points

    • Biological weathering: Chronic exposure to racism.

    • Neonatal Adaptation Syndrome: Mild, self-resolves, seldom requires treatment.

    • Perinatal loss: Conception through 28 days after birth

    • Prenatal anxiety: 15.8%.

    • PTSD in childbirth: 4%.

    • Misdiagnosis of Bipolar Disorder: 69% of women with perinatal bipolar are initially misdiagnosed with unipolar depression.

    • Bipolar disorder and PPD: 50% of first-time mothers with postpartum psychosis have no prior psychiatric hospitalization.

    • Common Postpartum OCD fears: Fear of deliberate harm (41%).

    • Prevalence of new-onset perinatal OCD: 30%.

    • Neonatal mortality rate: 28/1000

    • NICU parent mental health: 20-30% of NICU parents experience mental health disorders in the first postpartum year.

    • Breastfeeding and Depression: Depression suppresses prolactin and oxytocin; PPD is more common in women with pre-pregnancy diabetes; Thyroid dysfunction and anemia can reduce milk supply and cause depression; women with PMADs were more likely to stop breastfeeding before 6 months postpartum.

    • Postpartum Anxiety symptoms prevalence: 8-20%

    • Hormones in PMAD: Women with PMADs have similar hormone levels compared to non-PMAD women.

    • Perinatal bipolar disorders: 30% misdiagnosed for over 10 years; 45-52% relapse or exacerbate symptoms during pregnancy

    • Postpartum psychological risk factors: Past trauma, ambivalence about the maternal role, and unresolved losses.

    • Postpartum psychosocial stressors: Unwanted pregnancy; infertility issues; sick/colicky infant

    • Prevalence of PMADS: 15-20%.

    • Prevalence of PTSD: 12%, or up to 34% with traumatic birth.

    • Alcohol abuse among postpartum women: 40-49%.

    • Death ratios: White women: 12.7/100,000 live births ; other ethnic/racial groups; 14.4/100,000 live births

    • Perinatal panic disorder: 11% of new mothers. Symptoms: nervousness, panic attacks, worries, and fears.

    • Postpartum alcohol use: 40-49%

    • New mothers with perinatal OCD: 11%

    • Suicide/infanticide in perinatal psychosis: 5% suicide, 4.5% infanticide.

    • Economic burden of untreated PMADs: $14.2 billion annually

    • Pre and postnatal paternal anxiety: prevalence rates: 4.1% - 16%.

    • Elevated anxiety in NICU mothers: 27%

    • Difficulties with pregnancy: 10% of women between 15-44 reported difficulty getting/staying pregnant.

    • Military women and parenting: 16.8% female military members, 42% with children, 55% married and enter parenthood earlier.

    Medication/Treatment Details

    • SSRIs: Sertraline (Zoloft) is a common treatment.
    • Brexanolone: FDA-approved IV treatment for PPD.
    • Zuranolol: FDA-approved oral neurosteroid treatment for postpartum depression (PPD).

    Other Key Concepts and Statistics

    • Neonatal abstinence syndrome: Increased nearly five-fold between 2000-2014, coinciding with rising rates of opioid prescribing to pregnant women.
    • Cannabis use in pregnancy: Self-reported use: 2-5%.
    • Misc. conditions: Subsyndromal depression, Tokophobia (fear of pregnancy).
    • General population statistics: 12-month PTSD prevalence in American adults: 3.5%.
    • Military maternal mental health: Anxiety is 3x higher in transgender persons
    • General postpartum facts: 10-15% become depressed within 6 months.
    • Deaths/live births: 1200 women in the US experience complications that are fatal annually.
    • Illicit drug use in pregnancy: 5.4% of pregnant women (15-44) reported using illicit drugs in the past month.
    • Postnatal paternal depression: Associated with social/behavioral problems in children (boys), especially at age 3.
    • Postpartum anxiety: 8-20%
    • Perinatal loss: Occurs from conception to 28 days postpartum
    • Bipolar and initial symptoms: 60% of women with bipolar disorder present initially with depression.

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    Description

    Explore the prevalence and impact of Perinatal Mood and Anxiety Disorders (PMADs) among new parents. This quiz covers various disorders including postpartum depression, anxiety, and their symptoms. Learn about trauma-informed care and the significance of addressing these issues for better recovery outcomes.

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