1. What percentage of US adults use complementary and alternative medicine therapies (CAM) treatments each year?

• a)

  10%

• b)

  20%

• c)

  30%

• d)

  40%

• e)

  50%

2. Which of the following adverse events has/have been reported during bright light therapy?

• a)

  Sleep disturbance

• b)

  Agitation

• c)

  Hypomania or mania

• d)

  Hepatotoxicity

• e)

  Renal toxicity

3. Which of the following is/are true regarding perinatal mental illness?

• a)

  It has been recognised since the time of Hippocrates.

• b)

  It refers to mild mental disorders that resolve over a few weeks.

• c)

  It refers specifically to the phenomenon of postpartum psychosis.

• d)

  It includes depression and anxiety disorders emerging during pregnancy.

• e)

  It includes depression and anxiety only emerging post-partum.

4. Which of the following is/are true about the symptoms of perinatal depression?

• a)

  They are distinct from symptoms of depression that occur at other times in a woman’s life.

• b)

  They are adequately captured by the definition of depression in the American Psychiatric Association’s Diagnostic and Statistical Manual.

• c)

  They are often co-morbid with symptoms of anxiety disorders.

• d)

  They are usually mild.

• e)

  They have well defined diagnostic criteria agreed internationally.

5. Which of the following is/are true about postpartum psychosis?

• a)

  It occurs in between one out of 500 and one out of 1000 births.

• b)

  It usually occurs no sooner than 30 days after childbirth.

• c)

  It may include altruistic homicidal delusions.

• d)

  It usually represents bipolar disorder.

• e)

  Schizophrenia is the most common pre-existing metal illness.

6. Which of the following is/are risk factors for perinatal psychiatric disorders?

• a)

  History of depression or anxiety.

• b)

  Stressful life events.

• c)

  Oestradiol withdrawal.

• d)

  Relationship conflict with the partner.

• e)

  Alcohol misuse.

7. Which of the following statements is/are true about prenatal stress and the effects on the child?

• a)

  If the mother is anxious or depressed while she is pregnant her child will very likely be affected.

• b)

  Measurement of maternal cortisol is important, as it will show us whether her child is likely to be affected.

• c)

  Mild stress can increase the risk for an adverse child outcome.

• d)

  If the mother is anxious or depressed while she is pregnant, her child is more likely to be mixed handed.

• e)

  The effects of prenatal stress are mainly limited to the first trimester.

8. Which of the following statements is/are true about interventions for prenatal stress and the effects on the child?

• a)

  A prenatal diagnosis meeting the criteria for an anxiety or depressive disorder is the most important thing to look out for in the mother in order to help the outcome for her child.

• b)

  The Family Nurse Partnership was helpful because it was designed to reduce stress in the pregnant mother.

• c)

  We know that if we intervene with the mother, the outcome for the child will be improved.

• d)

  Both sitting down quietly in a chair and listening to music have been shown to reduce the pregnant mother’s plasma cortisol.

• e)

  We should be helping about 5% of pregnant women for their problems with stress during pregnancy.

9. Which of the following statements about neonatal behaviour after prenatal selective serotonin reuptake inhibitor exposure (SSRI) is/are true?

• a)

  Neonatal behavioural disturbances (often called postnatal adaptation syndrome [PNAS]) are distinguishable from exposure to antenatal maternal depressed mood.

• b)

  Research needs to focus on identifying risk factors that explain why, some but not all, neonates experience poor neonatal adaptation.

• c)

  PNAS symptoms are related drug dose of SSRI.

• d)

  PNAS symptoms are a function of type of SSRI medication and length of exposure.

• e)

  Management of PNAS symptoms requires specific treatment but, once managed, developmental risk is no greater than for non-exposed neonates.

10. Which of the following statements about congenital heart defects after prenatal SSRI exposure is/are true?

• a)

  Congenital heart defects have been consistently demonstrated after prenatal SSRI exposure across all trimesters.

• b)

  Paroxetine and fluoxetine use appears to slightly increases the risk of congenital defects.

• c)

  The risk for coronary heart disease after SSRI exposure can be distinguished from the influence of underlying maternal mental illness.

• d)

  Considerable uncertainty surrounds the clinical significance of the risk of congenital heart defects after SSRI exposure.

• e)

  Once the presence of congenital heart defects has been ruled out, neonatal developmental risks are no different from non-exposed neonates.

11. Women with a history of one prior episode of postpartum depression (PPD) who have a subsequent pregnancy have a recurrence rate of PPD of?

• a)

  2%

• b)

  10%

• c)

  25%

• d)

  50%

• e)

  75%

12. What is the lifetime risk of developing bipolar disorder in women who have had a psychiatric contact (outpatient or inpatient) in the first month postpartum?

• a)

  About 1%

• b)

  About 5%

• c)

  About 15%

• d)

  About 25%

• e)

  About 50%

13. Which of the following statements is/are true about health outcomes related to depression during pregnancy?

• a)

  It confers an increased risk of postpartum depression.

• b)

  It confers an increased risk of lactation failure or shortened duration.

• c)

  It increases the risk of preterm birth.

• d)

  It is associated with gestational diabetes.

• e)

  It is associated with ovarian cancer.

14. Which of the following statements is/are true about the effect of perinatal mood disorders and lactation?

• a)

  There is decreased initiation of lactation.

• b)

  There is reduced duration of breast feeding.

• c)

  There is increased nutritional content of breast milk.

• d)

  There is increased experience of painful lactation in the first 2 weeks of breast feeding.

• e)

  There is increased risk of long-term adverse maternal health outcomes.

15. High quality evidence of efficacy exists for delivery of psychotherapy for perinatal depression for which of the following modalities?

• a)

  Individual face-to-face psychotherapy

• b)

  Telephone-delivered psychotherapy

• c)

  Internet-delivered psychotherapy

• d)

  Group face-to-face psychotherapy

• e)

  Couples face-to-face psychotherapy

16. Meta-analyses of treatments for perinatal depression generally show that:

• a)

  Medication is superior to psychotherapy.

• b)

  Psychotherapy is superior to control conditions.

• c)

  Psychotherapies differ among one another in terms of efficacy.

• d)

  Manualised psychotherapies are superior to non-manualised therapies.

• e)

  IPT is superior to other psychotherapies.

17. Psychotherapy for perinatal depression is important because:

• a)

  It is safer than medication during pregnancy.

• b)

  It is preferred to medication by pregnant women.

• c)

  It has greater evidence of efficacy than medication during the perinatal period.

• d)

  Compliance with psychotherapy is greater than compliance with medication during the perinatal period.

• e)

  It is easier to deliver than medication during the perinatal period.

18. Which of the following statements is/are true about the stress-buffering effects of social support on mental health?

• a)

  Social support is hypothesised to prevent or modulate responses to stressful events that are damaging to health.

• b)

  Perceived availability of social support in the face of a stressful event may lead to a more benign appraisal of the situation.

• c)

  Perceived or received support may reduce the negative emotional reaction to a stressful event.

• d)

  The effectiveness of social support as a stress buffer does not require actually received or enacted support.

• e)

  The different forms of support are received equally well from different sources.

19. Which psychosocial intervention(s) has/have evidence that they work for treating postpartum depression?

• a)

  Good evidence supports the effectiveness of professionally facilitated support groups in the treatment of postpartum depression.

• b)

  Good evidence supports the effectiveness of self-help groups in the treatment of postpartum depression.

• c)

  Preliminary evidence shows effectiveness for telephone-based peer support in the treatment of postpartum depression.

• d)

  Partner support may be beneficial for treating postpartum depression straight after treatment.

• e)

  Partner support may be beneficial for treating postpartum depression several weeks after treatment.

20. Which psychosocial interventions have evidence that they do not work for treating postpartum depression?

• a)

  Evidence is lacking for the effectiveness of non-directive counselling in the treatment of mild-moderate postpartum depression.

• b)

  Evidence is lacking for the effectiveness of non-directive counselling in the treatment of severe postpartum depression.

• c)

  Evidence is lacking for the effectiveness of the use of antidepressants compared with listening visits in the treatment of postpartum depression.

• d)

  Home visits by mental health nurses are not presently supported by high-quality research evidence.

• e)

  Models of care showed no benefit for treating postpartum depression.

21. Which of the following is/are true about postpartum depression?

• a)

  It is the most frequent postpartum mental health disorder.

• b)

  It is defined as a major depressive episode with onset within 4 weeks after delivery.

• c)

  It increases the risk of adverse consequences on the child’s development.

• d)

  It is easily brought up by mothers during clinical encounters.

• e)

  New mothers often feel that they have no ‘right’ to be depressed

22. Which of the following is/are true about perinatal depression?

• a)

  The definition of perinatal depression is essentially based on observation as opposed to evidence-based criteria.

• b)

  It is defined as a major or minor depressive episode that occurs either during pregnancy or within the first 12 months after delivery.

• c)

  Maternal depressive symptoms that meet criteria for perinatal depression but not for postpartum depression are of little consequence for the development of the child.

• d)

  Standardised screening tools for perinatal depression are not available.

• e)

  Parent–infant therapy cannot start until after the baby is born.

23. When there is a past history of severe mental health disorders (postpartum or chronic), it is good practice to:

• a)

  Assess carefully antenatal and postnatal risks during pregnancy.

• b)

  Actively plan during pregnancy for a possible postpartum mental health relapse and potential admission to a mother and baby unit.

• c)

  Make a referral to a psychiatrist immediately and focus on obstetrical care.

• d)

  Work in tandem with mental health professionals to plan for postpartum care.

• e)

  Change drug regimens due to concerns of fetal abnormality.

24. Which of the following is/are true about mother and baby units?

• a)

  They are ubiquitous in the developed world.

• b)

  They are most common in European countries.

• c)

  In European countries with them they are most common in Germany.

• d)

  They are nearly non-existent in the USA.

• e)

  They can be found in some developing countries.

25. Which of the following is/are true about admission to mother and baby units?

• a)

  Admission is often through self-referral.

• b)

  Admission often occurs because no other treatment options are available.

• c)

  Admission may require several pre-admission outpatient visits to determine appropriateness.

• d)

  Admission always presumes that the mother will provide continuing care for the infant.

• e)

  Admission is undertaken because care in the mother baby unit is regarded as the best treatment option for the mother and her infant.

26. Which of the following is/are true about the purposes of a mother and baby unit?

• a)

  They ensure the development of a positive mother–infant relationship.

• b)

  They manage the mother’s psychiatric illness.

• c)

  They help the mother with her basic parenting skills.

• d)

  They relieve the extended family from the need to care for the child while the mother is in hospital.

• e)

  They monitor for risk of self harm and suicide.

27. Obstructive sleep apnoea (OSA) in pregnancy increases the risk of which of the following:

• a)

  Eclampsia

• b)

  Pregnancy-induced hypertension

• c)

  Congestive heart failure

• d)

  Myocardial infarction

• e)

  Pulmonary embolus

28. Which of the following is/are true about gestational restless legs syndrome (gRLS)?

• a)

  It is less prevalent than chronic restless leg syndrome (RLS).

• b)

  Sixty per cent of women who have gRLS in one pregnancy experience it in subsequent pregnancies.

• c)

  It is not associated with risk of RLS later in life.

• d)

  It dramatically improves in most women shortly after delivery.

• e)

  It is worse in the first trimester and improves as the pregnancy progresses.

29. Which of the following is/are predictors of postpartum insomnia?

• a)

  Smoking

• b)

  Breast feeding

• c)

  Sleeping separately from the newborn infant

• d)

  Vaginal delivery

• e)

  Caesarean delivery

30. Which of the following is/are true about pregnant women with narcolepsy?

• a)

  Body mass index is generally lower than in pregnant women without narcolepsy.

• b)

  Women with narcolepsy have an increased incidence of impaired glucose tolerance during pregnancy.

• c)

  Women with narcolepsy have an increased incidence of anaemia during pregnancy.

• d)

  Cataplexy during delivery is common.

• e)

  Sodium oxybate is considered safe for use during pregnancy.