nypost.com
Absolutely but when lay people read this it is likely leaving a lasting negative impression of medication and who knows how many women struggling will be afraid to take much needed medication. Blaming the medications, blaming the psychiatrist what a lousy way to attempt to justify a tragedy. I can't find the article I saw with what was supposedly the actual last regimen not the entire med trial history as above. If I recall it was only maybe 3-4? A SSRI, Ltg, low dose Seroquel possibly Mirtazapine? I can't speak for her case but in my opinion and experience Seroquel 50mg is definitely not overmedicating a patient with postpartum psychosis.
This is the same for kids... I saw a NY times article about how a kid was on 10 medications but they counted two pills of the same medication (Prozac 10mg+20mg for a total of 30mg) as two medications, not to justify this medication regimen.
<Not a doctor or student>
I think what is missing here is that psychosis is not the same across the board. There are various levels and severities of psychosis. Many people can respond well to a low dose seroquel. You don't treat a tiny mouse with a horse tranquilizer. I appreciate hearing your perspective. There are a lot of details of the story that we just aren't aware of, and, seroquel 50mg may have been an appropriate dose for her symptology at the time it was prescribed. In an ideal world if there were concerns about her safety, she would have been prescribed an involuntary hospitalization for observation and treatment.
So obviously everyone will react differently to medications, but your experience with seroquel is extremely atypical. At 50mg you're basically just taking an anti-histamine with some anticholinergic effects, so you might as well have been taking benadryl from a physiologic perspective. It doesn't really start having serotonergic effects until around 200mg and doesn't really start hitting dopamine until around 400mg. It does have linear effects, and unless your doc was planning on increasing by quite a bit I'm surprised you got it for tics.
Low-dose seroquel is not effective for primary psychotic disorders. If psychosis is secondary to insomnia, maybe, but for true psychosis? No. If they were suspecting insomnia-induced psychosis in the post-partum setting, benzodiazepines QHS would be first line here anyway. This isn't even an "ideal world" issue. If her psychiatrist knew she was truly psychotic with HI she should have been admitted and they could be legitimately screwed. I haven't read the case in depth, but admitting patients who are psychotic with HI and means to harming their target is standard of care.
Apparently she was inpatient for 5 days but insurance wouldn’t approve further days. She was doing intensive outpatient per reports.
Broken system. She probably was not even close to being ready for IOP and no one wants to pay for longer term residential treatment. The stress of trying to do IOP and take care of the kid almost guarantees worsening symptom.
Oh wow, that really boosts her defense (I say as a lay person). I wonder if the insurance company could be held liable?
That is true from a physician's perspective. But the undertreated argument segways into an insanity defense which you may know is not a get out of jail free card, but rather a one-way ticket to the state hospital for at least several years if it's a murder charge, and potentially decades locked in the state hospital. Different states handle NGRI hospital time differently. Some continually reevaluate a person's dangerousness and work towards monitored release from the hospital. Others keep you in the hospital until the maximum of your potential sentence if you had been convicted. Which for a murder charge is the rest of your life.
The fact that they are talking about NGRI or NGRII and not competency at this point means that nobody involved actually thinks she isn't going down for these charges. You don't start claiming insanity or involuntary intoxication until a fair amount later.
no, its unlikely. The insurance companies only make the decision to cover the stay; they do not tell the doctor whether or not they should be discharged. Ultimately the physician discharges, and in theory can still keep the person inpatient even if insurance stops covering the stay.
I'd be interested in seeing that article, as personal experience as well as what I was taught is that sedating effect of seroquel is also linear. However, for my personal experiences this may also be partially d/t patients developing tolerance to the histaminergic aspect of it and requiring higher doses as a result.
You could go up much quicker with seroquel (start at 200mg and increase to 400mg in 2-3 days), but there's just better options imo (like zyprexa). If they legit believes it was post-partum without an underlying psychotic disorder, lithium would be first line anyway.
Yikes, that makes it sound like this was likely a very avoidable outcome and all the more tragic.
I've had multiple cases with psychosis over the years and if med naïve my go-to is generally Li + Zyprexa to start. It tends to settle them and get them sleeping fairly quickly.
That is shameful. They should have some responsibility.
The only times I will choose to start seroquel for psychosis is if A) they've tried a bunch of other meds which weren't helpful and they're losing weight and not sleeping. B) They've been on seroquel before and it worked well. C) They've struggled with EPS even with low potency APs like olanzapine and clozapine isn't an option. For the last group you can obviously try prescribing to control the EPS, but I don't like the polypharm mess and have had a few where we legit couldn't give anything else for EPS (glaucoma + AUD hx + bradycardia).
Insurance calls themselves healthcare companies and their business model is to prevent treatment and they are shielded from liability. Important point is that we make money when we treat patients, they make money when patients aren’t treated or if they can get us to treat them out of the goodness of our hearts because we aren’t soulless corporate entities.
But are children always or even typically the targets of postpartum psychosis-induced violence? Is that inherent in postpartum psychosis? Is postpartum psychosis unique among psychoses? Are there some normal postpartum processes that aberrate or do the normal postpartum processes in some people produce what but for the timing is bread and butter psychosis? It seems that's common in cases you hear in the media that the mother targets children, but I don't know if that is true as a general rule. Those just might be the cases that garner the most attention, or also that the children are whom the mother is around the most, or that among the violence that takes place in this form of psychosis children are the least able to defend themselves, thus end up dead the most commonly, and thus in the news.
I don’t think we are just referring to the extreme negative outcome of violence. I certainly wasn’t. A severely depressed mother, especially one who is psychotic, is going to have difficulty responding to and meeting the needs of their infant appropriately. I am referring more to the attitude of society regarding mental health in general and the conflation of normal mood fluctuations and typical rapid recovery of mild to moderate case with the moderate to severe cases that need a more comprehensive approach to be effective that we are typically working with.
Most new mothers are not violent. But yes, when violence occurs, the child is the most typical victim.
Postpartum psychosis is a misnomer and there is some discussion about renaming it more appropriately. It appears to be a subtype of episode of bipolar disorder. Phenotypically it is not similar to primary psychotic disorders, which often present with negative symptoms like flat affect and social withdrawal. PPP more often presents with an agitated paranoia.
Ah, I see your confusion. Seroquel is an interesting med and does have linear sedation, but like any other med there will eventually be a plateau of the effect once occupancy of the receptor responsible for the sedation (largely histamine here) reaches a high enough level. Seroquel is interesting because it continues to have further effects (though not so much sedating) as you increase dose even once the histamine receptor occupancy has plateaued. So I guess it would be most accurate to say that seroquel has linear sedating effects up to around 300-400mg, but does not at doses above that.
