Saha Rahul, Singh Shubh Mohan, Nischal Anil
Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Department of Psychiatry, Post Graduate Institute of Medical Educational & Research, Chandigarh, India.
Shanghai Arch Psychiatry. 2015 Oct;27(5):311-4. doi: 10.11919/j.issn.1002-0829.215058.
This case report describes a 30-year-old mother of four with a 6-year history of obvious paranoia and psychosis from a poor rural farming community in India. Her symptoms and social functioning deteriorated over time, but the family did not seek medical care until she killed her 3-month-old daughter while under the influence of command hallucinations. Subsequent treatment with antipsychotic medication resulted in control of her psychotic symptoms and greatly improved psychosocial functioning. This case is an example of one of the many negative consequences of a community's failure to recognize and treat mental illnesses. The patient had severe symptoms that were obvious to all for 6 years prior to the infanticide, but the family's lack of basic knowledge about mental illness, the lack of locally available mental health care, and the relatively high cost of care prevented family members from obtaining the treatment that almost certainly would have prevented the tragic death of her infant. Changing these three factors in poor rural communities of low- and middle-income countries is the challenge we must work together to address. Infanticide secondary to untreated mental illness is a glaring reminder of how urgent this task is.
本病例报告描述了一位来自印度贫困农村农业社区的30岁母亲，她育有四个孩子，患有明显的偏执和精神病已有6年病史。随着时间的推移，她的症状和社会功能逐渐恶化，但家人直到她在命令性幻听的影响下杀死自己3个月大的女儿后才寻求医疗帮助。随后使用抗精神病药物进行治疗，控制了她的精神病症状，并极大地改善了她的心理社会功能。这个案例是社区未能识别和治疗精神疾病所带来的众多负面后果之一。在杀婴事件发生前的6年里，患者的严重症状对所有人来说都很明显，但由于家人缺乏关于精神疾病的基本知识、当地缺乏心理健康护理以及护理费用相对较高，家庭成员无法获得几乎肯定可以避免其婴儿悲剧死亡的治疗。改变低收入和中等收入国家贫困农村社区的这三个因素是我们必须共同努力应对的挑战。未经治疗的精神疾病导致的杀婴行为鲜明地提醒我们这项任务是多么紧迫。
