Pirec Vesna
Eating Recovery Center/Insight in Chicago, 333 North Michigan Ave, Suite 1900, Chicago, IL 60601, USA.
Department of Psychiatry, University of Illinois at Chicago, 921 S. Wood, Chicago, IL 60612, USA.
Case Rep Psychiatry. 2018 Feb 20;2018:8262043. doi: 10.1155/2018/8262043. eCollection 2018.
This case report describes a primipara without documented psychiatric history prior to complicated delivery. Onset of severe insomnia and anxiety was right after childbirth but not treated. Obsessive thinking pattern became more prominent. The patient became depressed and sought psychiatric help four months after delivery. Insomnia was then treated pharmacologically. Anxiety and depression persisted, suicidal ideation emerged, and the patient became confused, indecisive, overwhelmed, and delusional regarding her child's health. Medications for depression and anxiety were started six months postpartum yet were ineffective. The patient's obsessions gradually became fully psychotic and she committed an altruistic infanticide eight months postpartum. Psychiatric hospitalization occurred, followed by a long course of mental, physical, legal, and social rehabilitation. She was minimally responsive to psychopharmacological treatment, which appeared to be partly related to her hormonal dysregulation. Several months into the treatment she gradually started improving and returned to baseline two years later. The Illinois court found the patient not guilty to murder by reason of Insanity.
本病例报告描述了一名初产妇，在复杂分娩前无精神病史记录。严重失眠和焦虑在产后立即出现，但未得到治疗。强迫思维模式变得更加突出。患者产后四个月出现抑郁并寻求精神科帮助。随后对失眠进行了药物治疗。焦虑和抑郁持续存在，出现了自杀意念，患者对孩子的健康变得困惑、犹豫不决、不堪重负且产生妄想。产后六个月开始使用治疗抑郁和焦虑的药物，但无效。患者的强迫观念逐渐完全发展为精神病性症状，她在产后八个月实施了利他性杀婴行为。随后她被送入精神病院住院治疗，接着经历了漫长的心理、身体、法律和社会康复过程。她对精神药物治疗反应甚微，这似乎部分与她的激素失调有关。治疗几个月后她逐渐开始好转，两年后恢复到基线水平。伊利诺伊州法院判定该患者因精神错乱而无罪。
