Antipsychotics and Pregnancy

[razorman]

I'm being faced with a challenge here and I'm hoping for some advice.

I have a young lady in my practice who is pregnant. She's hypothyroid (treated and controlled) and undoubtedly has a mood disorder. Her attitude makes her one of the more challenging patients that I deal with. She arrived stating that she's having auditory, visual, and tactile hallucinations. She's also taken to cutting herself. Her description of her hallucinations are pretty inconsistent with how real psychotic delusions actually manifest. I described them to the psychologist that comes into our office occasionally and he agrees they're probably not actually occurring. She has a history of medication seeking and I had to take her off of a lot of various medications when she first presented to me (already 2 months along).

I don't think that this girl is having psychotic hallucinations but I do think that she needs help with moods. I'm not sure, however, how to best balance her needs with that of her unborn child. I don't want to just throw medications at her and buy into her game but I also don't want her to go running and taking just random things to fulfill whatever need she has for medications. Has anyone run into anything like this that can point me in the right direction?

I did make a referral to the County psychiatrist for her. It's going to be several weeks before she can be seen.

[zenman]

I'm being faced with a challenge here and I'm hoping for some advice.

I have a young lady in my practice who is pregnant. She's hypothyroid (treated and controlled) and undoubtedly has a mood disorder. Her attitude makes her one of the more challenging patients that I deal with. She arrived stating that she's having auditory, visual, and tactile hallucinations. She's also taken to cutting herself. Her description of her hallucinations are pretty inconsistent with how real psychotic delusions actually manifest. I described them to the psychologist that comes into our office occasionally and he agrees they're probably not actually occurring. She has a history of medication seeking and I had to take her off of a lot of various medications when she first presented to me (already 2 months along).

I don't think that this girl is having psychotic hallucinations but I do think that she needs help with moods. I'm not sure, however, how to best balance her needs with that of her unborn child. I don't want to just throw medications at her and buy into her game but I also don't want her to go running and taking just random things to fulfill whatever need she has for medications. Has anyone run into anything like this that can point me in the right direction?

I did make a referral to the County psychiatrist for her. It's going to be several weeks before she can be seen. .

Psychotic symptoms do seem to worsen during pregnancy. How does she act when she's alone, for ex., sitting in the waiting room? Does she appear to be hallucinating then? As for meds, just check the pregnancy ratings. Of the atypicals, I think only clozapine has a rating of B, others are C or D. In any case risks to fetus has to be weighted against whether she needs treatment or can wait.

[t2krookie]

Hypothyroid,a new cutter @ 15, and preggers with alleged psychosis decompensation? Was she psychotic before? Long past time to pass that buck. The trifecta in hallucinations is very questionable. Sounds like a bigtime axis 2 but ya got a big mess there it seems.