PMH-C Exam with Complete Solutions
Military Stressors - ANS-Recent/upcoming deployment
Potential lack of emotional support from partner
Fear for welfare or self or partner
Living without partner
Single parenting
Concerns about childcare
Inadequate support:
Location away from friends and family
Possibility of no established relationships with recent move
Lack of providers who understand military culture
Lack of providers for beneficiaries
Lack of providers who accept insurance
Lack of peer support due to "army strong" mentality
Lack of disclosure to others due to "small town"
Lack of ability to provide peer support due to own needs
Focus often on active duty member's psychological issuesv
Jane Honikman - ANS-Founder of PSI
What year was PSI established? - ANS-1987
Louis Victor Marce - ANS-French psychiatrist who wrote first treatise on puerperal
(about six weeks after childbirth) mental illness
James A. Hamilton - ANS-Father of Postpartum Psychiatric Illness
Wrote book: Postpartum Psychiatric Problems
Founded the Marce Society
Advocate of research, treatment and social support movement
DAD - ANS-Depression After Delivery (USA)
APNI - ANS-Association for Post Natal Illness (England)
PANDA - ANS-Post and Ante Natal Depression Association (Australia)
Postpartum Education for Parents - ANS-Postpartum Education for Parents (USA)
Most important part of mental health for women, children, and families - ANS-Social
support
,How many countries does PSI have members in? - ANS-Over 40 countries
What percentage of women will experience postpartum depression? - ANS-21%
What percentage of pregnant woman will experience moderate to severe symptoms of
depression and/or anxiety? - ANS-20%
What percentage of pregnant women with psychiatric diagnosis were treated? - ANS-
Less than 86%
What percentage of women on antidepressants were symptomatic due to suboptimal
treatment? - ANS-Over 50%
The perinatal period - ANS-The entire time frame from pregnancy through the first year
after giving birth
PMAD - ANS-Perinatal Mood (depression and bipolar) Anxiety (GAD, panic, OCD,
PTSD) Disorders
What percentage of pregnancies are unplanned? - ANS-50%
PMDD - ANS-Premenstrual dysphoric disorder
Sensitive to hormonal changes
Risk factor for PMAD
What disorders classify as a PMAD? - ANS-Depression
Anxiety and Panic disorder
OCD
PTSD
Perinatal Bipolar
Psychosis
Perinatal depression - ANS-Most under diagnosed obstetric complication in America
Increased costs of medical care
Inappropriate medical care
Child abuse and neglect
Discontinuation of breastfeeding
Family dysfunction
Adversely affects early brain development
40% of cases are detected and diagnosed
60% receive treatment
Prevalence for Prenatal anxiety - ANS-15.8%
,Prevalence for postpartum anxiety - ANS-8% - 20%
PMADs in Fathers - ANS-1 in 10 men will get anxiety/depression
Fathers with higher ACE scores reported more pregnancy-related anxiety than did
fathers with lower scores at all time points
Reported more depressive feelings during pregnancy
9.2% had depression prenatally
Maternal depression increased the risk of paternal depression
- Initial high after birth may give way to depression
- Masked male depression (substance use, irritable, aggressive)
- Distancing
- Distractions and habits
Medication - ANS-50-75% relapse (depression and anxiety) after discontinuing
medication while pregnant
Over 40% resume medication during pregnancy
The benefit out weights the risk when on medication during pregnancy
Normal Pregnancy symptoms - ANS-Mood is labile, teary
Self esteem is normal
Sleep: bladder or heartburn may awaken. Can fall asleep
No suicidal ideology
Energy: may tire, rest restores
Pleasure: joy and anticipation (appropriate worry)
Appetite: increases
Depression Symptoms - ANS-Mood: persistent gloom
Low self-esteem, guilt
Sleep: early a.m. awakening
Suicidal thoughts, plans, or intentions
Energy: rest does not restore
Fatigue
Anhedonia
Poor appetite
Sadness, crying
Guilt and shame
Hopeless and helplessness
Overwhelm
, Lack of feelings toward baby
Isolation
"This doesn't feel like me"
Worthlessness
Mood swings
Inability to care for self and family
baby blues - ANS--NOT a mild form of clinical depression
- Affects 60-80% of new moms
- Mild
- Lasts no more than 2 days to 2 weeks
- Predominant mood is happiness
- Common to have tearfulness, lability, reactivity
- Peaks 3-5 days after delivery
- Present in diverse cultures
- Unrelated to stress or psychiatric history
- Acute sleep deprivation
-Different in from PPD in length and severity
- Symptoms: mood swings, anxiety, sadness, irritability, crying, decreased
concentration, trouble sleeping
-Very common to feel this way, hormones have to readjust
-Every mother experiences some type of baby blues, it's normal
Blues or Depression? - ANS-Severity
Timing
Duration
Anxiety Symptoms - ANS-Agitated, irritable
Inability to sit still
Excessive concern about the baby's or her own health
High alert
Appetite changes
Sleep disturbances
Constant worry
Racing thoughts
Shortness of breath
Heart palpitations
Panic Symptoms - ANS-Episodes of extreme anxiety
Shortness of breath, chest pain, sensation of choking or smothering, dizziness
Hot or cold flashes, trembling, rapid heart rate, numbness or tingling
Restlessness, agitation, irritability
Excessive worry or fear
Panic may wake her up
Military Stressors - ANS-Recent/upcoming deployment
Potential lack of emotional support from partner
Fear for welfare or self or partner
Living without partner
Single parenting
Concerns about childcare
Inadequate support:
Location away from friends and family
Possibility of no established relationships with recent move
Lack of providers who understand military culture
Lack of providers for beneficiaries
Lack of providers who accept insurance
Lack of peer support due to "army strong" mentality
Lack of disclosure to others due to "small town"
Lack of ability to provide peer support due to own needs
Focus often on active duty member's psychological issuesv
Jane Honikman - ANS-Founder of PSI
What year was PSI established? - ANS-1987
Louis Victor Marce - ANS-French psychiatrist who wrote first treatise on puerperal
(about six weeks after childbirth) mental illness
James A. Hamilton - ANS-Father of Postpartum Psychiatric Illness
Wrote book: Postpartum Psychiatric Problems
Founded the Marce Society
Advocate of research, treatment and social support movement
DAD - ANS-Depression After Delivery (USA)
APNI - ANS-Association for Post Natal Illness (England)
PANDA - ANS-Post and Ante Natal Depression Association (Australia)
Postpartum Education for Parents - ANS-Postpartum Education for Parents (USA)
Most important part of mental health for women, children, and families - ANS-Social
support
,How many countries does PSI have members in? - ANS-Over 40 countries
What percentage of women will experience postpartum depression? - ANS-21%
What percentage of pregnant woman will experience moderate to severe symptoms of
depression and/or anxiety? - ANS-20%
What percentage of pregnant women with psychiatric diagnosis were treated? - ANS-
Less than 86%
What percentage of women on antidepressants were symptomatic due to suboptimal
treatment? - ANS-Over 50%
The perinatal period - ANS-The entire time frame from pregnancy through the first year
after giving birth
PMAD - ANS-Perinatal Mood (depression and bipolar) Anxiety (GAD, panic, OCD,
PTSD) Disorders
What percentage of pregnancies are unplanned? - ANS-50%
PMDD - ANS-Premenstrual dysphoric disorder
Sensitive to hormonal changes
Risk factor for PMAD
What disorders classify as a PMAD? - ANS-Depression
Anxiety and Panic disorder
OCD
PTSD
Perinatal Bipolar
Psychosis
Perinatal depression - ANS-Most under diagnosed obstetric complication in America
Increased costs of medical care
Inappropriate medical care
Child abuse and neglect
Discontinuation of breastfeeding
Family dysfunction
Adversely affects early brain development
40% of cases are detected and diagnosed
60% receive treatment
Prevalence for Prenatal anxiety - ANS-15.8%
,Prevalence for postpartum anxiety - ANS-8% - 20%
PMADs in Fathers - ANS-1 in 10 men will get anxiety/depression
Fathers with higher ACE scores reported more pregnancy-related anxiety than did
fathers with lower scores at all time points
Reported more depressive feelings during pregnancy
9.2% had depression prenatally
Maternal depression increased the risk of paternal depression
- Initial high after birth may give way to depression
- Masked male depression (substance use, irritable, aggressive)
- Distancing
- Distractions and habits
Medication - ANS-50-75% relapse (depression and anxiety) after discontinuing
medication while pregnant
Over 40% resume medication during pregnancy
The benefit out weights the risk when on medication during pregnancy
Normal Pregnancy symptoms - ANS-Mood is labile, teary
Self esteem is normal
Sleep: bladder or heartburn may awaken. Can fall asleep
No suicidal ideology
Energy: may tire, rest restores
Pleasure: joy and anticipation (appropriate worry)
Appetite: increases
Depression Symptoms - ANS-Mood: persistent gloom
Low self-esteem, guilt
Sleep: early a.m. awakening
Suicidal thoughts, plans, or intentions
Energy: rest does not restore
Fatigue
Anhedonia
Poor appetite
Sadness, crying
Guilt and shame
Hopeless and helplessness
Overwhelm
, Lack of feelings toward baby
Isolation
"This doesn't feel like me"
Worthlessness
Mood swings
Inability to care for self and family
baby blues - ANS--NOT a mild form of clinical depression
- Affects 60-80% of new moms
- Mild
- Lasts no more than 2 days to 2 weeks
- Predominant mood is happiness
- Common to have tearfulness, lability, reactivity
- Peaks 3-5 days after delivery
- Present in diverse cultures
- Unrelated to stress or psychiatric history
- Acute sleep deprivation
-Different in from PPD in length and severity
- Symptoms: mood swings, anxiety, sadness, irritability, crying, decreased
concentration, trouble sleeping
-Very common to feel this way, hormones have to readjust
-Every mother experiences some type of baby blues, it's normal
Blues or Depression? - ANS-Severity
Timing
Duration
Anxiety Symptoms - ANS-Agitated, irritable
Inability to sit still
Excessive concern about the baby's or her own health
High alert
Appetite changes
Sleep disturbances
Constant worry
Racing thoughts
Shortness of breath
Heart palpitations
Panic Symptoms - ANS-Episodes of extreme anxiety
Shortness of breath, chest pain, sensation of choking or smothering, dizziness
Hot or cold flashes, trembling, rapid heart rate, numbness or tingling
Restlessness, agitation, irritability
Excessive worry or fear
Panic may wake her up
