We will take the baby

One of my patients is a 18 year of girl who recently gave birth to a baby boy. She had no prenatal care and was never seen during her entire pregnancy. She spent a portion of her pregnancy on the streets. She entered the hospital to give birth and upon giving birth the ob/gyn ran a tox screen on the mother and the baby. The tox screen was positive only for marijuana for both the baby and the mother. So they took the baby and turned it over to dcfs. Upon learning this the mother became severely agitated and attacked several staff members. She punched, kicked and screamed for hours. She was admitted to the psych floor directly from the maternal ward. I was assigned to her to manage her treatment.

I went into her room to introduce my self. Upon saying "hello" she immediately started shouting saying "give me my mother blanking baby right now you mother %&%$&!" She preceded to get out of the bed and tried to engage me in a fight. Fortunately I had no interest in sparring with the patient so I excused myself and ordered up some medications for her. After a while she was more sedated and I was able to examine her and get a history. 

This girl has had a long and hard life and she is only 18 years old. As a young girl she was molested and raped numerous times by her mother's different boyfriends. She spent time living with her mother on the street and eating from garbage cans at the age of 3 to 6. Her mother was in and out of apartments and shelters. Her mother had a psychiatric history of mental illness and drug abuse. By the time the patient was 12 years old she had become exceedingly difficult to manage and her mother could not handle her. Her mother dropped her off at a child / teen psychiatric residence in the suburbs where she became property of the state. The patient lived in the state facility from the age of 12 - 18. 

Her first pregnancy was at 14 but she lost the pregnancy under questionable circumstance possibly a self induced abortion or street abortion. She was diagnosed as Bipolar / manic by a psychiatrist and treated successfully in the state facility. About 1 year ago she turned 18 and left the facility to live on the street and in various shelters. She quit taking her medications and began abusing drugs and practicing prostitution. Ultimately she became pregnant and spent the majority of her pregnancy on the streets. She went into labor last week and was taken to the hospital to deliver. After the delivery and prior to the tox screen the staff noticed that she was abnormally excited / manic. 

She was put in our psych ward and was very difficult to manage, requiring restraints and medication to sedate her. She attacked staff and other patients. She was remarkably strong. I was able to interview her in the peak of her mania and she explained to me that she had not slept in 'weeks". Her speech was very fast and she jumped from idea to idea very rapidly. She also explained to me that she had super powers and could control people with her thoughts. She felt because of this she was above the law. She was also very agitated. 

These are common signs of mania. Many people think that mania is being excited and having a sense of euphoria. However in all the cases of real mania I have seen there has been a break with reality. Some of the psychiatrist I am working with require this loss of reality to really call the episode mania. Others are more lenient with the term. I am of the thought that true mania presents like this patient with pressured speech, severe agitation, grandiosity, no sleep, and loss of touch with reality. My mentor told me today that most true bipolar patients will be diagnosed once the patient is forced into the hospital involuntarily. She also is leery to diagnose true bipolar without this type of hospitalization. In other words for a true diagnosis of Bipolar one of the signs and or symptoms will be involuntary hospitalization. I would say that this is what I have seen so far as well. The mania in these patients is so out of control that they loose touch with reality and ultimately find themselves in a psych ward extremely agitated. Usually they can't remember the incident once they come down.

The amazing thing with my patient was that once I was able to medicate her she became a whole different person. She transformed from so type of feral tasmanian devil to a nearly normal 18 year old teenaged. She became very polite and realistic about her situation. She was no longer agitated and was and actual talked of getting herself togther so that she could become a good mother. I think that if she continues her medication and remains off the streets she has a very good chance of ultimately regaining custody of her child. We are preparing for her discharge after some more observation. We have had her on the unit for nearly 1 week and the transformation has been incredible.