Question (1) Post partum ....... ?!

[dr_b.e.s.m]

Two days after delivering a healthy, full-term baby girl, a 25-year-old woman becomes acutely agitated and disoriented. She refuses to feed her baby, stating that the baby is born of the devil. She hears voices telling her to drown her daughter if she wants to save her soul. Which of the following is the next best step?

A. The woman is having a full-blown episode of schizophrenia
B. The baby should be removed by a child protection agency immediately
C. The woman should be warned never to have another child
D. The woman's disorder is most closely related to schizophrenia
E. The woman should be treated with antipsychotic and antidepressant medications

[anwarica]

So scarry 

I'll choose B

(Just my guess  )

[dr_ahmedsalah]

So funny.
I didn't expect that medicine will be like a horror movie. I love those movies.

i did not stydy psychiatry yet but it is TV experience

the disorder is away from schizophrenia.

and for sure no one can say to a women do not give birth again

so it most likely be  B   OR   E

or we will need an exorcist to kill those devils 

[eman]

dr ahmad   i  think the answer will be  E     

[dr_ahmedsalah]

We are all waiting for dr_besm to put us on the right tract

[anwarica]

Somehow I feel it will be (B) 

[dr_ahmedsalah]

what is more IMPORTANT thAn B IS TO KNOW WHY
AND WHY U EXCLUDED OTHER ANSWERS

[musheera]

Asalam alikom...
OK
Apsychiatry Q I think I have to answer...I hope I'm not wrong b/c if I am then I'm in big trouble...
I htink the right answer is E...
This seems a picture of postpartum psychosis

Regarding other answers
We cannot give a diagnosis of scizophrenia before 1 month of symptoms
Atleast 2 positive symptoms should be there
"Symptoms are typically divided into positive and negative symptoms because of their impact on diagnosis and treatment.
 Positive symptoms are those that appear to reflect an excess or distortion of normal functions. The diagnosis of schizophrenia, according to DSM-IV, requires at least 1-month duration of two or more positive symptoms, unless hallucinations or delusions are especially bizarre, in which case one alone suffices for diagnosis. Negative symptoms are those that appear to reflect a diminution or loss of normal functions. These often persist in the lives of people with schizophrenia during periods of low (or absent) positive symptoms. Negative symptoms are difficult to evaluate because they are not as grossly abnormal as positives ones and may be caused by a variety of other factors as well (e.g., as an adaptation to a persecutory delusion). However, advancements in diagnostic assessment tools are being made."
http://www.schizophrenia.com/


B The baby should not be removed but the mother needs to be closely supervised as not to harm the baby..
breast feeding should be continued even with meds...

The following is some info on the subject




The Range of Postpartum Conditions

The "baby blues." This condition occurs in many new mothers in the days immediately following childbirth (3).  It is characterized by sudden mood swings, which range from euphoria to intense sadness. Symptoms may include crying for no apparent reason; impatience; irritability; restlessness; anxiety; feelings of loneliness, sadness, and low self-esteem; increased sensitivity; and heightened feelings of vulnerability. The "baby blues" may last only a few hours or as long as one to two weeks after delivery. The condition may disappear as quickly and as suddenly as it appeared, without medical treatment. (4)

Postpartum depression (PPD). Roughly 10% of pregnancies result in postpartum depression (5), which can occur a few days or even months after delivery. Postpartum depression can occur after the birth of any child, not just the first (6). This condition is characterized by more intense feelings of sadness, despair, anxiety, and irritability. It often disrupts a woman's ability to function, which is the key sign that medical attention is necessary.

Left untreated, symptoms may worsen and linger for as long as a year. This physical disorder, however, can be diagnosed and its symptoms alleviated (7).

Postpartum psychosis. This serious mental illness affects approximately 1 in 500-1,000 new mothers (. Onset is severe and quick, usually within the first three months after delivery. Women who suffer from postpartum psychosis may completely lose touch with reality, often experiencing hallucinations and delusions (9). Other symptoms may include insomnia, agitation, and bizarre feelings and behavior (10).

Postpartum psychosis should be treated as a medical emergency. Patients need immediate medical assistance, which almost always includes medication. In many cases, women who are suffering from this condition are hospitalized (11).

Who is At Risk for Postpartum Depression?

Any woman who is pregnant, had a baby within the past several months, miscarried, or recently weaned a child from breastfeeding can suffer from postpartum depression. A woman can have this condition regardless of her age, socioeconomic status, or the number of children she has borne (12).

Postpartum depression is more likely to occur if a woman had any of the following:

previous postpartum depression
depression not related to pregnancy
severe premenstrual syndrome (PMS)
a non-supportive partner; and stress related to family, marriage, occupation, housing, and other events during pregnancy or after childbirth (13).
Symptoms of Postpartum Depression

Symptoms of postpartum depression include

restlessness, irritability, or excessive crying;
headaches, chest pains, heart palpitations, numbness, hyperventilation;
an inability to sleep or extreme exhaustion or both;
loss of appetite and weight loss, or, conversely, overeating and weight gain;
difficulty concentrating, remembering, or making decisions;
an excessive amount of concern or disinterest in the baby;
feelings of inadequacy, guilt, and worthlessness;
a fear of harming the baby or one's self;
a loss of interest or pleasure in activities, including sex (14).
Women who have a previous history of mood disorders, such as depression, are at an increased risk of relapse after delivery (15). At least 33% of women who have had postpartum depression have a recurrence of symptoms after a subsequent delivery (16). As many as 60% of women with the psychiatric condition known as bipolar disorder have a relapse after childbirth (17). Fortunately, prenatal screening can identify these women during their pregnancy (18).

Some women may not be depressed, but they may feel very anxious. These women might suffer from postpartum anxiety or panic disorder. Symptoms can include intense anxiety and fear, rapid breathing, an accelerated heart rate, hot or cold flashes, chest pain, and shaking or dizziness (19).

Factors Associated with Postpartum Depression

Postpartum depression is a complex mixture of biological, emotional, and behavioral changes. The exact cause of this condition is still unknown (20).

A variety of hormonal changes may trigger its symptoms. Estrogen and progesterone levels-which increase tenfold during pregnancy to accommodate the growing fetus-suddenly and rapidly drop in the first 24 hours after childbirth. After delivery, these hormones fall to even lower levels, to pre-pregnancy levels (21). These decreases may trigger depression, just as smaller hormonal changes can affect a woman's moods before menstruation (22).

Thyroid levels may also drop sharply after birth. A thyroid deficiency can produce symptoms that mimic depression, such as mood swings, severe agitation, fatigue, insomnia, and anxiety. Simple thyroid tests can determine if this condition is causing a woman's postpartum depression (23).

Aside from biological changes, a variety of physical, psychological, and environmental factors can lead to postpartum depression.

Feelings of fatigue following delivery, broken sleep patterns, and insufficient rest often prevent a new mother from regaining her full strength for weeks, especially if she has had a cesarean delivery (24).
Taking responsibility for an expanding family can be overwhelming. Some new mothers have feelings of self-doubt and inadequacy. They may doubt their ability to be a good mother (25).
Many new mothers suffer from stress, which can be caused by changes in work and home routines. Stress can also be caused by the pressure a woman places on herself to be the "perfect mother," a highly unrealistic goal (26).
New mothers often experience feelings of loss. After the birth of a baby, many women feel a loss of identity, a loss of control, a loss of a slim figure, and a perceived loss of physical attractiveness (27).
In addition, their free time is suddenly restricted, they are confined indoors for long periods of time, and they have less time to spend with their baby's father (28).
Treating Postpartum Depression

Postpartum depression is treated much like other types of depression. The most common treatments for depression are antidepressant medication, psychotherapy, participation in a support group, or a combination of these treatments. However, some antidepressants can contaminate breast milk. Women who breastfeed should talk to their doctors to determine the most suitable treatment option (30).

The most appropriate treatment depends on the nature and severity of the postpartum depression and, to some extent, on individual preference. It is important to recognize that postpartum depression is both temporary and treatable.

New mothers with postpartum depression can practice a number of self-care strategies.

Good, old-fashioned rest is important. Always try to nap during the baby's nap time.
Relieve some of the pressure you may be feeling. Do as much as you can, and leave the rest. If possible, ask your husband or partner to share night-time feeding duties and household chores.
To help you through the readjustment process, seek out emotional support from your husband or partner, family, and friends.
Isolation often perpetuates the depression. Get dressed and leave the house for at least a short time each day.
Make an effort to spend time alone with your partner.
Ask your physician to advise you on possible medical treatments. Be assertive about your concerns. Not all health care professionals recognize the symptoms or seriousness of postpartum depression. Get a referral to a mental health professional who specializes in treating depression (31).
Talk with other mothers, so you can learn from their experiences.
Join one of the many support groups that are now available to help women who suffer from postpartum depression. Call a hotline to access information and services



http://www.wrongdiagnosis.com/artic/postpartum_depression_fact_sheet_nwhic.htm

I hope this is usefull
Fe aman Allah!!!!!
Musheera

[dr_b.e.s.m]

-I don't have the correct answer for this question? but? ?We don't need to separate the baby. I read this on the website ( www.gpnotebook.co.uk ) :

"Treatment of puerperal psychosis usually entails admission to hospital, preferably with the baby.? ? In this setting the relationship between mother and baby can be preserved without putting the baby at risk."

So B isn't the correct answer and E is the most appropriate answer. Thanks Dr Musheera.

-And anyway, the risk of infanticide in this case is around 4% that's if left without treatment. With treatment and close observation the risk is less than this, so the baby isn't in a great danger.A good rapidly effective treatment is ECT so I think it can be used in cases with severe symptoms and we are worried about infanticide!


-What's about the answer D. The woman's disorder is most closely related to schizophrenia ?

Well, I read that although this condition is called puerperal psychosis? , it's more related to mood disorders (eg. bipolar and schizo affective) than being related to schizophrenia!

-Breast feeding can be continued but if mood stabilizers eg Lithium are used then breast feeding is better avoided as it's secreted in high levels in breast milk.

-Prophylaxis in next pregnancy isn't through avoidance of having more children but with prophylactic Lithium started just prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum. Prophylactic lithium appears to significantly reduce relapse rates, as well as to diminish the severity and duration of puerperal illness.

[dr_ahmedsalah]

الله  اكبر 
الاجابه طلعت E

THX DR BESM

[dr_b.e.s.m]

General guidelines for post partum psychiatric problems. If you wanna read more about it , just scroll up and read the post of doctor Musheera!


"Two days after delivering a healthy, full-term baby girl, a 25-year-old woman becomes acutely agitated and disoriented. She refuses to feed her baby, stating that the baby is born of the devil. She hears voices telling her to drown her daughter if she wants to save her soul."