MedEd PPD

EmergencyAssessment

What is a postpartum psychiatric emergency? There are three types of emergent situations:

Risk of harm to self (suicidality)
Risk of harm to others (homicidality)
Inability to provide basic care for self (usually due to psychosis). Psychosis is associated with both suicidality and homicidal ideation toward the infant or others.

Suicidality/Homicidality
If you suspect that a mother is suicidal or homicidal:

Do not leave the patient by herself or alone with baby until you can complete an assessment and plan for her safety!
Explore suicidality with the Edinburgh Postnatal Depression Scale
If the mother answers anything other than "never" to question 10 of the EPDS, use the format suggested in the Cox questionnaire (see page 27 and 28 of linked source) for further assessment
Implement agency or practice guidelines for self-harm, suicidal or homicidal ideation; or access the Mental Health Services Locator for specific services in your area
Discuss with the mother her willingness to engage in treatment planning that includes a safety plan
Refer the mother for immediate mental health assessment
Engage support system (discuss importance of involving partner, family)
Document evidence in medical record

Suicide Prevention Hotlines:

http://www.1800ppdmoms.org/

National Hopeline Network: 1-800-784-2433
http://www.hopeline.com/

National Suicide Prevention Lifeline: 1-800-273-8255
http://www.suicidepreventionlifeline.org/

Postpartum Psychosis

If you believe a mother has postpartum psychosis:

Postpartum psychosis is a psychiatric emergency. Do not leave the patient by herself or alone with baby until you can complete an assessment and plan for her safety and her child's safety!
Assess the mother's affect and presentation:
- Delusions (particularly the altruistic homicide delusion: the child would be better off dead, the mother believes she is saving the child from a fate worse than death by harming the baby, or the mother is overly protective of the child without cause, such as not allowing her partner to bathe or touch the baby)
- Hallucinations (particularly auditory hallucinations that command the mother to hurt the baby or herself)
- Fear of harming baby (differentiate from obsessional intrusive thoughts: ego alien; may be experienced as images of knives, bloody baby, etc.; protective behaviors; experienced inside the head)
- Irritability or extremely labile mood
- Erratic sleep patterns not related to the child's sleep pattern
Assess for risk factors
- Previous history of bipolar disorder, mania, psychosis, or postpartum psychosis
- Personal or family history of mental illness including bipolar disorder or schizophrenia
- Implement agency or practice guidelines for self-harm, suicidal or homicidal ideation; or access the Mental Health Services Locator for specific services in your area
- Discuss with the mother her willingness to engage in treatment planning that includes a safety plan
- Refer the mother for immediate mental health assessment
- When necessary, contact local child protective services
Additional Information
Psychiatric Hospitalization and Involuntary Commitment
http://www.healthyminds.org/psychiatrichospitalization.cfm
Mental Health Bill of Rights for Psychiatric Treatment
http://www.healthyminds.org/patientsbillofrights.cfm