Intrusive thoughts in a 32-year-old woman
Outpatient Perinatal Psychiatry & OB/GYN ClinicJessica Wiley · 32yo female · CC: Intrusive thoughts about harming the baby
History
0/6 key findingsAsk the questions your differential demands — not just the ones the case volunteers. Every diagnosis you intend to list owes you one discriminating question.
CASE SETTING: OUTPATIENT PERINATAL PSYCHIATRY & OB/GYN CLINIC
Jessica Wiley, a 32-year-old woman 4 weeks postpartum with distressing intrusive thoughts
Vitals
Opening
Jessica Wiley, a 32-year-old primiparous woman who delivered a healthy term daughter 4 weeks ago, presents urgently to the clinic with her husband, Mark, because she has been crying and terrified by recurring mental flashes of dropping her baby down the stairs. Jessica is seated closely next to her husband while holding the infant carrier, visibly distressed and asking whether she is "going crazy."
Triage note
32-year-old G1P1 female 4 weeks status post uncomplicated vaginal delivery presenting with acute distress over intrusive thoughts involving her newborn. Vitals normal. Exclusively breastfeeding.
From the patient
"Every time I walk past our staircase or give her a bath, this horrifying mental image pops into my head—what if I drop her down the stairs? It makes me sick to my stomach because I love her more than anything."
Jessica Wiley · 32yo female
Tearful and anxious when describing her thoughts, holding her newborn gently and attentively alongside her husband