Post Partum Intrusive Thoughts

[Poety2]

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ie throwing a baby in front of a train, dropping baby on the head, smashing it against the wall.... PPD? or early PPP?

experts in teh field say intrusive thoughts defined by disturbing, transient thoughts of hurting baby or self that leave mom distressed as part of post partum depression OR normal post partum period.... but where is teh line when this can turn into psychosis?

Anyone with experience?

I just had to start reading MOthers who kill after this patient left the office

 

[DrIng]

Can be a variety of things, can be depressive illness, can be psychosis, can also be OCD.
The main thing is a reasonable risk assessment; are the impulses ego syntonic or dystonic, do they have other supports, past history, can they resist the impulses etc.
And then balance up risk of harm to child vs risk of harm to relationship between mother and child if child removed etc etc. I'd say talk to a senior colleague and get a 'team decision'. Don't try and make these decisions on your own (and review the patient frequently.)

 

[Solideliquid]

Can be a variety of things, can be depressive illness, can be psychosis, can also be OCD.
The main thing is a reasonable risk assessment; are the impulses ego syntonic or dystonic, do they have other supports, past history, can they resist the impulses etc.
And then balance up risk of harm to child vs risk of harm to relationship between mother and child if child removed etc etc. I'd say talk to a senior colleague and get a 'team decision'. Don't try and make these decisions on your own (and review the patient frequently.)

ALso, talk to the family, and ask them to continually monitor for these thoughts.

 

[Poety2]

I got supervision immediately for this patient - I was just wondering what others experiences were with them, how they felt about it, what they did, etc etc. - I nor anyone else I think felt "comfortable" handling this patient, since you never really know. We struggled with issues of detention orders, etc in the face of no support.

Anyone else seen this?

 

[OldPsychDoc]

I got supervision immediately for this patient - I was just wondering what others experiences were with them, how they felt about it, what they did, etc etc. - I nor anyone else I think felt "comfortable" handling this patient, since you never really know. We struggled with issues of detention orders, etc in the face of no support.

Anyone else seen this?

I think we're all scared silly by this (I just spent 30 days trying to discharge a young woman whose case manager wanted locked up until her baby was born because of the girls honesty about her fears!) because bad things do happen with post-partum psychosis. DrIng's point about assessing whether the thoughts are ego-dystonic or not, the nature and quality of the mom's supports, the presence of other danger signals in the overall presentation, etc., is a really important one.

Personally, I've had intrusive thoughts about my babies--fear I would fall or stumble carrying them down the stairs, etc. We can't just knee jerk to any mention of "I'm afraid I might hurt my baby" without exploring the entire picture.

 

[Poety2]

I think we're all scared silly by this (I just spent 30 days trying to discharge a young woman whose case manager wanted locked up until her baby was born because of the girls honesty about her fears!) because bad things do happen with post-partum psychosis. DrIng's point about assessing whether the thoughts are ego-dystonic or not, the nature and quality of the mom's supports, the presence of other danger signals in the overall presentation, etc., is a really important one.

Personally, I've had intrusive thoughts about my babies--fear I would fall or stumble carrying them down the stairs, etc. We can't just knee jerk to any mention of "I'm afraid I might hurt my baby" without exploring the entire picture.

I agree OPD, these were specific - about a specific harm to self and baby - however, this patient has ocpd too. OPD I'm sure you know patients are WAYYY more complex than just straight forward x,y,z - thats what happened in this case. It was interesting to see, although I'm sure overly frightful for the patient as well.

I"ve had the intrusive thoughts of "what if I hurt the avatar" but once I got a handle on how to take care of her, they dissipated quickly. THis patient has been having them since pregnancy = and violent.

I just think this whole topic should be discussed more. Luckily, we have a PPD/PPP expert on our faculty 👍

So, what did you do with the patient OPD? What network of support did you set up for her? Mine has none in the immediate area and hubby is back to work. My attending graciously took over this case 😳

 

[Puffle]

I read an article in the lay press talking about post-partums intrusive thoughts, and they are much more common that originally thought; in both mothers and fathers. It went on to say that most thoughts revolved around accidently hurting the child, forgetting it someone, or inadvertantly touching it sexually while changing diapers. The thoughts were transient, often receeding by 3-5 months post-partum and occurred in up to 30% of otherwise "normal" parents. It's just that the thoughts are so utterly disturbing, they are vastly under-reported.