PMH-C Perinatal Mental Health Disorders & Assessment 5 — Questions and Answers
Question 1: A 32-year-old woman at 6 weeks postpartum denies depression but scores 13 on the EPDS. She reports her worst symptom is constant worry about her baby's health. Which additional screening tool would be most useful?
- PHQ-2
- PC-PTSD-5
- GAD-7 (Correct answer)
- MDQ (Mood Disorder Questionnaire)
Correct answer: GAD-7
The GAD-7 is a validated tool for assessing generalized anxiety disorder severity and would complement the EPDS by quantifying her predominant anxiety symptoms.
Question 2: Which of the following presentations should prompt a clinician to screen specifically for bipolar disorder in a postpartum patient presenting with mood symptoms?
- Onset of depressive symptoms at 6 weeks postpartum
- Family history of bipolar disorder, rapid mood shifts, and decreased need for sleep (Correct answer)
- Persistent crying with normal thyroid function tests
- Mild irritability attributed to sleep deprivation
Correct answer: Family history of bipolar disorder, rapid mood shifts, and decreased need for sleep
Family history of bipolar disorder combined with rapid mood cycling and decreased need for sleep are red flags warranting bipolar screening before initiating antidepressant monotherapy.
Question 3: The EPDS item that most directly assesses panic is:
- Item 4 ('I have been anxious or worried for no good reason')
- Item 5 ('I have felt scared or panicky for no very good reason') (Correct answer)
- Item 6 ('Things have been getting on top of me')
- Item 8 ('I have felt sad or miserable')
Correct answer: Item 5 ('I have felt scared or panicky for no very good reason')
EPDS item 5 directly asks about feelings of being scared or panicky without a clear reason, making it the most targeted item for panic-like experiences.
Question 4: Infanticide risk in postpartum psychosis is most directly associated with which psychotic feature?
- Auditory hallucinations of music
- Command hallucinations or delusions instructing harm to the infant (Correct answer)
- Visual hallucinations of light patterns
- Thought disorganization without delusional content
Correct answer: Command hallucinations or delusions instructing harm to the infant
Command hallucinations or delusions (e.g., the belief that the infant must die to be 'saved') directly drive infanticide risk in postpartum psychosis.
Question 5: A perinatal mental health clinician is conducting a comprehensive assessment. Which domain is LEAST likely to be included in a validated perinatal mental health intake evaluation?
- History of trauma and adverse childhood experiences
- Detailed financial investment portfolio review (Correct answer)
- Social support and relationship quality
- History of prior perinatal mood or anxiety disorders
Correct answer: Detailed financial investment portfolio review
Financial investment details are not clinically relevant to perinatal mental health risk assessment; social support, trauma history, and prior PMAD history are all established domains.
Question 6: Which of the following is an evidence-based psychotherapy with the strongest support for treating postpartum depression?
- Psychoanalytic therapy
- Cognitive-behavioral therapy (CBT) (Correct answer)
- Hypnotherapy
- Supportive counseling alone
Correct answer: Cognitive-behavioral therapy (CBT)
CBT has the strongest evidence base for treating postpartum depression, with multiple RCTs demonstrating efficacy comparable to antidepressant medication.
Question 7: A postpartum patient reports she had 'the baby blues' that never went away — she has been tearful, exhausted, and detached from her infant for 8 weeks. The correct clinical interpretation is:
- Baby blues lasting this long are normal for first-time mothers
- This presentation is consistent with postpartum depression requiring clinical assessment and treatment (Correct answer)
- The patient likely has a thyroid disorder rather than a mood disorder
- Baby blues that persist indicate postpartum psychosis
Correct answer: This presentation is consistent with postpartum depression requiring clinical assessment and treatment
Baby blues lasting beyond two weeks that are accompanied by functional impairment and detachment from the infant meet criteria for postpartum depression, not postpartum blues.
PMH-C Perinatal Mental Health Disorders & Assessment 5
A 32-year-old woman at 6 weeks postpartum denies depression but scores 13 on the EPDS.
She reports her worst symptom is constant worry about her baby's health.
Which additional screening tool would be most useful?