Hy 2288 A pregnant psychotic depressed lady

[tommyk]

Hy 2288

q) You now see another pregnant young lady who is “seeing things and hearing things” (that are not real) and is suicidal and depressed at her 1st trimester. She asks you for help. Which is best?

1) Valium
2) Fluoxetine
3) Clonazepam
4) Lorapezam
5) Short acting benzo (Xanax)
6) ECT (Electroconvulsive Therapy)
7) Counseling























































































































Ans) ECT. The benzos are contraindicated (short, medium, or long acting), esp. in first trimester. It will give rise to anomalies like cleft lip and palate. SSRI work too slow and the patient is suicidal. Counseling is not enough for a suicidal psychosis. You must choose Electro convulsive therapy.

[md90]

thought that they don't do ECT these days...

[tommyk]

Actually they do, my bro md90. They do it all the time. I just saw it done myself.

BUT, it is NOTHING like the "old days". They usually do a unilateral ECT where one "lead" is placed on the temporal area, and the other in the midline. The cost is about $1000.00 per treatment, and insurance companies WILL pick it up for patients who are "pregnant" or "refractory" to medical management.

I also thought they sit in a chair and get "electrocuted" like in an "execution", and I thought they stopped all that, but it is nothing like what you imagine.

They are usually sedated, put to sleep, and then the actually time is only about 15 seconds. Their whole body shakes only a little. And after, the toes wiggle back and forth for several seconds because you basically INDUCED a seizure.

Strangely, it does seem to work on a lot of people. But again, it ain't anything like what you saw in the movies...

And I HOPE no one in our ValueMD family will need it!!

Sincerely,

Tommyk

[md90]

Another question.. instead of doing the ECT, could you not admit the woman and monitor her and the baby? And also are there not any effects on the baby?

[tommyk]

Yes, you "could" admit her. That could have been a good answer choice but she could leave AMA (against medical advice) since she would have to be in the psych unit for many months. At that point, insurance companies may stop payment. Also, if she is psychotic, hospitals will be upset if you do not initiate some kind of treatment. Electroconvulsive therapy is indictated in this setting. But of course, you would do a "unilateral" and not a "bilateral" ECT. And...you would closely monitor vitals. Since the seizure occurs in mom, you should not affect the baby. However, I do not know if the data would support aggressive ECT therapy like every day for 9 months. I do think that would definitely be bad. Usually, ECT is done only a few times and once every few days while the patient is admitted. Then it is stopped for a while. It is far more benign than people think. And again, it really does work. It seems too cruel a treatment, but patients agree to it all the time.

[md90]

thank you tommyk...