Anxiety Disorders in Pregnancy Flashcards

Which statement about the Edinburgh Postnatal Depression Scale (EPDS) use in pregnancy is most accurate?

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.

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:

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.

Which prenatal anxiety presentation should prompt the clinician to specifically screen for bipolar disorder before initiating antidepressant therapy?

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.

What is the significance of the 11-item Wijma Delivery Expectancy Questionnaire (W-DEQ) in perinatal anxiety assessment?

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.

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?

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.

Which factor most distinguishes pathological health anxiety in pregnancy from normal maternal concern about fetal well-being?

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.

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:

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.