Psychosis in Pregnancy and the Neonatal Ripple Effect.

BACKGROUND

Postpartum mood disorders including depression and psychosis are well documented conditions. However, new-onset psychosis in pregnancy is less common and less well studied with fewer reports available.

CLINICAL CASE: A 36-year-old Gravida 6 Para 3113, non-English-speaking patient with no known history of mood disorder outside of pregnancy presented for her scheduled repeat cesarean delivery and was diagnosed with new-onset peripartum psychosis. She was admitted to the antepartum service and underwent an extensive workup to rule out organic causes, which all returned negative results. The patient was initially medically managed, and her mental status improved to where she was able to assent for her cesarean delivery while consent was obtained from the patient's next of kin. After delivery the patient and neonate continued to be managed with an interdisciplinary team to ensure the safety of mother and child. The neonate was transferred to the newborn nursey with supervised visits with the patient and was ultimately discharged home with the father. The patient was managed inpatient on the postpartum floor; however, she ultimately required transfer to an inpatient psychiatry unit where she received higher-level psychiatric care until she improved and was cleared to go home with close outpatient follow-up.

CONCLUSION

This is one of the few published cases of new-onset psychosis in pregnancy. It highlights the importance of addressing mental health concerns in our patients as well as the vital interdisciplinary team management to ensure the safety of our patients and their families. The paucity of data around these presentations is notable and there exists an opportunity for further investigation into mental health and reproductive psychiatry to help improve outcomes.