PMH-C Perinatal Mental Health Disorders & Assessment 3 — Questions and Answers
Question 1: A woman with a history of bipolar I disorder becomes pregnant. Compared to the general population, her risk of postpartum psychosis is:
- Similar to the general population
- Slightly elevated at about 5%
- Substantially elevated at 25–50% (Correct answer)
- Only elevated if she discontinues medication
Correct answer: Substantially elevated at 25–50%
Women with bipolar I disorder have a markedly elevated risk of postpartum psychosis, estimated at 25–50%, compared to approximately 1–2 per 1,000 in the general population.
Question 2: Which of the following best describes the concept of 'birth trauma' in perinatal mental health?
- Physical injury sustained by the infant during delivery
- A subjective experience of distress during or after childbirth that may lead to PTSD symptoms (Correct answer)
- Operative delivery requiring forceps or vacuum
- Maternal hemorrhage requiring transfusion
Correct answer: A subjective experience of distress during or after childbirth that may lead to PTSD symptoms
Birth trauma refers to the psychological experience of childbirth as traumatic, which may lead to PTSD-like symptoms regardless of objective medical complications.
Question 3: Which neurotransmitter system is most implicated in the rapid hormonal withdrawal theory of postpartum mood disorders?
- Dopaminergic system
- Serotonergic system
- GABAergic system influenced by allopregnanolone (Correct answer)
- Noradrenergic system
Correct answer: GABAergic system influenced by allopregnanolone
The sharp postpartum drop in allopregnanolone (a progesterone metabolite that modulates GABA-A receptors) is strongly implicated in perinatal mood dysregulation.
Question 4: A postpartum patient scores 14 on the EPDS and endorses item 10 (self-harm ideation). What is the recommended immediate clinical response?
- Schedule routine follow-up in 4 weeks
- Document the score and rescreen in 2 weeks
- Conduct a full suicide risk assessment and create a safety plan (Correct answer)
- Refer to psychiatry but defer action until the appointment
Correct answer: Conduct a full suicide risk assessment and create a safety plan
Endorsement of EPDS item 10 (suicidal ideation) requires immediate comprehensive suicide risk assessment and safety planning regardless of the total score.
Question 5: Perinatal anxiety affects approximately what percentage of pregnant and postpartum women?
- 1–3%
- 5–8%
- 15–20% (Correct answer)
- 30–40%
Correct answer: 15–20%
Research consistently estimates that anxiety disorders affect approximately 15–20% of perinatal women, making it at least as common as perinatal depression.
Question 6: Which statement about postpartum blues is accurate?
- Postpartum blues typically require antidepressant treatment
- Postpartum blues peak around days 3–5 and resolve within two weeks (Correct answer)
- Postpartum blues are characterized by psychotic features
- Postpartum blues occur in fewer than 10% of new mothers
Correct answer: Postpartum blues peak around days 3–5 and resolve within two weeks
Postpartum blues are a normative, self-limiting emotional response peaking around days 3–5 postpartum, typically resolving within two weeks without pharmacological intervention.
Question 7: A clinician is assessing a postpartum patient for depression. Which EPDS item is designed to assess anhedonia?
- Item 1 (ability to laugh) (Correct answer)
- Item 3 (blaming oneself unnecessarily)
- Item 7 (sleeping difficulties)
- Item 10 (thoughts of self-harm)
Correct answer: Item 1 (ability to laugh)
EPDS item 1 ('I have been able to laugh and see the funny side of things') assesses hedonic capacity, a core feature of depression.
PMH-C Perinatal Mental Health Disorders & Assessment 3
A woman with a history of bipolar I disorder becomes pregnant.
Compared to the general population, her risk of postpartum psychosis is: