PMH-C Postpartum Depression 3 — Questions and Answers
Question 1: Edinburgh Postnatal Depression Scale (EPDS) question 10 asks about self-harm thoughts. A patient scores 2 on this item. What is the MOST appropriate immediate action?
- Document and reassess at the next visit
- Conduct a full suicide risk assessment immediately (Correct answer)
- Refer to a psychiatrist without further evaluation
- Prescribe antidepressants and schedule follow-up in 2 weeks
Correct answer: Conduct a full suicide risk assessment immediately
Any positive response on EPDS item 10 regarding self-harm requires immediate comprehensive suicide risk assessment before any other clinical decision is made.
Question 2: Which of the following factors has been shown to be MOST protective against developing postpartum depression?
- Elective cesarean delivery
- High perceived social support (Correct answer)
- Primiparous status
- Formula feeding
Correct answer: High perceived social support
High perceived social support is one of the strongest protective factors against PPD, buffering the psychological and physiological stress of the postpartum period.
Question 3: Brexanolone (Zulresso) was FDA-approved specifically for postpartum depression. What is its mechanism of action?
- Selective serotonin reuptake inhibition
- Positive allosteric modulation of GABA-A receptors (Correct answer)
- Norepinephrine-dopamine reuptake inhibition
- Serotonin-norepinephrine reuptake inhibition
Correct answer: Positive allosteric modulation of GABA-A receptors
Brexanolone is a synthetic form of allopregnanolone that acts as a positive allosteric modulator of GABA-A receptors, directly targeting the neurological mechanism underlying PPD.
Question 4: A mother at 3 months postpartum discloses she feels like a 'failure as a mother' and has been avoiding taking her newborn out in public. Which cognitive distortion is MOST evident?
- Catastrophizing
- Mind reading
- All-or-nothing thinking (Correct answer)
- Fortune telling
Correct answer: All-or-nothing thinking
All-or-nothing (black-and-white) thinking is evident when the mother views herself as a complete failure based on imperfect maternal performance, without acknowledging successes.
Question 5: Which finding from the infant's perspective is a documented consequence of maternal postpartum depression if left untreated?
- Advanced gross motor development
- Higher rates of cognitive and language delays (Correct answer)
- Decreased stranger anxiety
- Earlier sleep consolidation
Correct answer: Higher rates of cognitive and language delays
Children of mothers with untreated PPD show higher rates of cognitive, language, and socioemotional developmental delays due to disruptions in early caregiving interactions.
Question 6: A perinatal mental health clinician is working with a Latina postpartum client who attributes her symptoms to 'nervios.' What is the MOST culturally competent approach?
- Correct her terminology and use only DSM-5 diagnostic labels
- Explore her cultural explanatory model while integrating it with evidence-based assessment (Correct answer)
- Defer treatment until she accepts a Western diagnosis
- Refer her to a Spanish-speaking clinician only
Correct answer: Explore her cultural explanatory model while integrating it with evidence-based assessment
Culturally competent care involves exploring the client's explanatory model and integrating cultural understanding with evidence-based assessment to build therapeutic alliance.
Question 7: What distinguishes postpartum blues from postpartum depression in terms of duration?
- Baby blues resolves within 2 weeks; PPD persists beyond 2 weeks (Correct answer)
- Baby blues resolves within 1 week; PPD persists beyond 3 days
- Baby blues lasts up to 6 weeks; PPD lasts longer than 6 weeks
- Baby blues and PPD have identical duration but differ in severity only
Correct answer: Baby blues resolves within 2 weeks; PPD persists beyond 2 weeks
Postpartum blues typically self-resolves within the first 2 weeks postpartum, while postpartum depression is defined by symptoms persisting beyond 2 weeks and meeting MDD criteria.
PMH-C Postpartum Depression 3
Edinburgh Postnatal Depression Scale (EPDS) question 10 asks about self-harm thoughts.
A patient scores 2 on this item.
What is the MOST appropriate immediate action?