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  #1  
Old 06-08-2011
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Psyche This is the Devil's baby!

25 yrs old, primigravid, comes to physician at 12 wks gestation. Pt. has history of schizoaffective disorder, was taking haloperidol, but stopped 2 months ago on her own. Pt. wants to get an abortion done as she feels this is Devil's baby. She hears angelic voices saying to get abortion done. She loves children but cannot keep this as it is devil's baby. On examination, uterus is 12 weeks in size, with rest of physical examination normal. Pt. is agitated. You admit the pt. in hospital, and then, what is the next step ---

a] don't do abortion and observe the pt.
b] don't do abortion and begin valproic acid.
c] don't do abortion and resume haloperidol
d] arrange for abortion and start valproic acid
e] arrange for abortion and resume haloperidol
f] arrange for abortion and resume haloperidol after abortion
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Old 06-08-2011
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valproic acid and haloperidol are contraindicated during preg...so i think ans should be A
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Old 06-08-2011
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I think we should consider if the patient is competent or not ,otherwise we can't decide whether to perform abortion or not ,so probably for the time being the answer would be A ,any other suggestions ?
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Old 06-09-2011
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""To date, no definitive association has been found between use of antipsychotics during pregnancy and an increased risk of birth defects or other adverse outcomes. However, there is a paucity of information, with a lack of large, well designed, prospective comparative studies.""

So i feel that the option will be to not to do the abortion and start the patient on haloperidol
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Old 06-09-2011
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c] don't do abortion and resume haloperidol

She needs treatment regarding her acute psychosis. Haloperidol has a short period of action and it should not harm the fetus. More over, she is at 12 weeks of gestation and she has already passed the critical period of organogenesis (3-8wks).
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Old 06-09-2011
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Hello there,

We went through this pretty recently! See The concept of Incompetent Patients

Yes I suggested get treatment for psychosis, not for TOP because she is neither competent nor has capacity to weigh up risks and benefits of TOP!
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Old 06-09-2011
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thank u all.. so heres the answer according to the responses above.. as i myself dont have an answer for this.. came across this in NBME..

she is schizoaffective disorder patient, and not in state to make desicion due to her auditory hallucination - so dont listen to her, dont do abortion..

also, her psychosis has to be taken care of, so resume haloperidol..
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Old 06-09-2011
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haloperidol is cat c drug..acoording to fda....so it can be given to preg women if benefits of drug to preg women outweigh possible risk to her unborn child....so my doubt in this case is that is it good decision to give drug and if yes for how long?
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Quote:
Originally Posted by MTBCK View Post
thank u all.. so heres the answer according to the responses above.. as i myself dont have an answer for this.. came across this in NBME..

she is schizoaffective disorder patient, and not in state to make desicion due to her auditory hallucination - so dont listen to her, dont do abortion..

also, her psychosis has to be taken care of, so resume haloperidol..
Thanks for the answer, but you have to tell us before hand that whether its an NBME question or not. It makes the predictability value of the NBMEs unreliable for people who still have to take the NBMEs.
Next time please label it at the top "NBME question"
Thank you
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MedicoLegal-Ethics, Psychiatry-, Step-2-Questions

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