Abstract

Background

Pregnancy denial can be broken into two major types, non-psychotic and psychotic deniers, and further classified into pervasive, affective and persistent sub-types. It can lead to increased morbidity and mortality of the mother and neonate. Psychotic pregnancy denial is rare and the medical literature existing on the subject is limited to a small number of case reports and case series. No formal recommendation exists on the clinical management of psychotic pregnancy denial in the antenatal or postpartum period. The authors provide a comprehensive review of the literature regarding psychotic pregnancy denial, present an example of an unpublished case and provide suggestions for clinical management.

Case

A 33-year-old primigravida at 37 6/7 weeks gestation presented with new-onset psychotic pregnancy denial with no prior history of psychosis. She had a negative medical work-up for organic causes of psychosis. Using a multidisciplinary approach, the decision was made to deliver the fetus at 38 1/7 weeks via cesarean section due to concerns for patient and fetal safety. Following delivery, she was admitted to an inpatient psychiatric facility and underwent 16 bilateral electroconvulsive therapy (ECT) treatments to which she showed complete response.

Conclusion

Psychotic pregnancy denial is rare and potentially dangerous. Delivery prior to 39 weeks gestation is reasonable for worsening psychiatric disease but careful consideration of the risk–benefit analysis and ethical framework must be deliberated.

Teaching points: In cases of worsening psychiatric disease in pregnancy, a multidisciplinary approach is necessary for comprehensive care. Psychotic denial of pregnancy leads to increased maternal and neonatal morbidity and mortality. Delivery prior to 39 weeks gestational age is reasonable to expedite psychiatric treatment.

Precis

Using a multidisciplinary approach, the decision to deliver before 39 weeks gestation is reasonable for worsening psychiatric disease.

中文翻译：

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精神病性妊娠否认：文献回顾及其临床考虑

摘要

背景

妊娠否认可分为两种主要类型，非精神病性否认者和精神病性否认者，并进一步分为普遍性、情感性和持续性亚型。它可能导致母亲和新生儿的发病率和死亡率增加。精神病性妊娠否认很少见，现有关于该主题的医学文献仅限于少数病例报告和病例系列。在产前或产后否认精神病性妊娠的临床管理尚无正式建议。作者全面回顾了有关否认精神病性妊娠的文献，展示了一个未发表的案例，并为临床管理提供了建议。

案子

一名 33 岁的初产妇，妊娠 37 6/7 周，因新发精神病性妊娠被否认，既往无精神病史。她对精神病的器质性病因进行了阴性医学检查。出于对患者和胎儿安全的担忧，采用多学科方法，决定在 38 1/7 周时通过剖宫产分娩胎儿。分娩后，她住进了精神病院，接受了 16 次双侧电痉挛治疗 (ECT)，她表现出完全反应。

结论

精神病性妊娠否认是罕见的并且具有潜在危险。妊娠 39 周前分娩对于加重精神疾病是合理的，但必须仔细考虑风险-收益分析和伦理框架。

教学要点：在妊娠期精神疾病恶化的情况下，需要多学科方法进行综合护理。精神病性否认妊娠导致孕产妇和新生儿发病率和死亡率增加。在孕周 39 周之前分娩对于加快精神科治疗是合理的。

精确

使用多学科方法，在妊娠 39 周前分娩的决定对于恶化的精神疾病是合理的。