PMH-C Anxiety Disorders in Pregnancy 5 — Questions and Answers
Question 1: Which statement about the Edinburgh Postnatal Depression Scale (EPDS) use in pregnancy is most accurate?
- It cannot be used prenatally as it was only validated postpartum
- It has been validated for antenatal use and can detect prenatal anxiety as well as depression (Correct answer)
- It must be combined with the PHQ-9 to have any validity in pregnancy
- It detects only depression and not anxiety symptoms prenatally
Correct answer: It has been validated for antenatal use and can detect prenatal anxiety as well as depression
The EPDS has been validated for antenatal use, and its anxiety subscale (items 3, 4, 5) specifically identifies prenatal anxiety symptoms.
Question 2: A woman at 28 weeks presents with new-onset compulsive checking behaviors (e.g., checking fetal movement 30+ times/day) that interfere with daily functioning. The clinician should first:
- Reassure her that checking behaviors are universally normal in pregnancy
- Assess for OCD with perinatal onset using a validated tool and explore distress and impairment (Correct answer)
- Immediately start an SSRI without further assessment
- Refer to the obstetrics team for fetal monitoring to address the underlying concern
Correct answer: Assess for OCD with perinatal onset using a validated tool and explore distress and impairment
Compulsive checking that causes functional impairment warrants formal OCD assessment; not all checking is normal, and impairment distinguishes disorder from typical behavior.
Question 3: Which prenatal anxiety presentation should prompt the clinician to specifically screen for bipolar disorder before initiating antidepressant therapy?
- Anxiety with marked sleep disturbance and low energy
- Anxiety alternating with periods of decreased need for sleep, elevated mood, and increased goal-directed activity (Correct answer)
- Anxiety with weight loss and poor appetite
- Anxiety with prominent somatic complaints and medical utilization
Correct answer: Anxiety alternating with periods of decreased need for sleep, elevated mood, and increased goal-directed activity
Anxiety that alternates with hypomanic or manic features (elevated mood, decreased sleep need, increased activity) suggests bipolar disorder, where SSRIs alone can precipitate mania.
Question 4: What is the significance of the 11-item Wijma Delivery Expectancy Questionnaire (W-DEQ) in perinatal anxiety assessment?
- It screens for generalized anxiety disorder severity in pregnancy
- It measures fear of childbirth and is the most widely used tool for tokophobia assessment (Correct answer)
- It assesses postpartum bonding anxiety after delivery
- It quantifies separation anxiety related to NICU admission
Correct answer: It measures fear of childbirth and is the most widely used tool for tokophobia assessment
The W-DEQ is the most widely validated and used tool for measuring fear of childbirth (tokophobia) and is a standard research and clinical measure in this area.
Question 5: A patient at 10 weeks gestation with GAD asks if her anxiety could affect her child's long-term emotional development. Based on current evidence, which response is most accurate?
- Prenatal anxiety has no documented effect on child emotional outcomes
- Severe, prolonged prenatal anxiety has been associated with increased emotional and behavioral problems in offspring (Correct answer)
- Mild anxiety in pregnancy is beneficial for fetal brain development
- Only postpartum anxiety affects child emotional development, not prenatal anxiety
Correct answer: Severe, prolonged prenatal anxiety has been associated with increased emotional and behavioral problems in offspring
Longitudinal cohort studies have shown that severe, chronic prenatal anxiety is associated with increased rates of emotional and behavioral problems in children, likely via HPA axis programming.
Question 6: Which factor most distinguishes pathological health anxiety in pregnancy from normal maternal concern about fetal well-being?
- The presence of any worry about fetal health
- Reassurance-seeking that provides only brief relief followed by return of anxiety, with significant functional impairment (Correct answer)
- Attendance at all scheduled prenatal appointments
- Use of fetal Doppler monitors at home
Correct answer: Reassurance-seeking that provides only brief relief followed by return of anxiety, with significant functional impairment
Pathological health anxiety is characterized by reassurance that provides only transient relief and by significant functional impairment, distinguishing it from normal adaptive concern.
Question 7: A PMH-C clinician is developing a safety plan for a pregnant patient with severe anxiety who endorses passive thoughts of death ('I wish I could just sleep and not wake up'). The immediate priority is to:
- Dismiss the statement as anxiety-related catastrophizing
- Assess for active suicidal ideation, intent, and access to means, and document the risk assessment (Correct answer)
- Immediately hospitalize the patient on a 5150 hold
- Refer to the OB team and avoid discussing suicide to prevent ideation reinforcement
Correct answer: Assess for active suicidal ideation, intent, and access to means, and document the risk assessment
Any passive death wish requires a structured suicide risk assessment including ideation, intent, plan, and means before determining the appropriate level of care.
PMH-C Anxiety Disorders in Pregnancy 5
Which statement about the Edinburgh Postnatal Depression Scale (EPDS) use in pregnancy is most accurate?