PeriPAN Case of the Month – February 2024
Each month, OBs and PCPs call PeriPAN with a wide variety of mental health questions. Find out how PeriPAN helped an OB during this consultation.
Patient:
G1P0 at 11 weeks with a past psychiatric history of anxiety and depression and a PMHx of obesity.
Reason for PeriPAN Consultation:
Seeking a new psychiatrist for a perinatal patient on a complex psychotropic regimen.
Explanation of the Case and Outcome of the Call:
The MFM called PeriPAN to obtain recommendations for a new psychiatrist for the patient. The patient states that she was under the care of a psychiatrist until 4-6 months ago and that the patient “lost access” to the psychiatrist. Pt states that her current medication regimen includes five psychiatric meds: bupropion, buspirone, propranolol, desvenlafaxine and risperidone. The pt told the MFM that she is not interested in discontinuing any of her medications as she has found the combination very effective for her. She told MFM that she had been treated with bupropion and buspirone since 2016 and the other medications were added more recently. I briefly reviewed safety data for her five medications during pregnancy (individually considered safe if use indicated and provides mental stability). We discussed that ideally her medication regimen could be simplified to minimize the exposure. MFM agreed with my statement and said that while she was okay with prescribing the five medications at this initial visit, she would like to refer her to a psychiatrist due to the polypharmacy and medications used (SGA). I informed the MFM that she could fill out an online referral form for The Women’s Place (reproductive psychiatry clinic) to facilitate the referral. MFM was very pleased to learn of this way to refer patients. The patient is scheduled to see a repropsych 14 days after the referral was made. The patient was offered an appointment 7 days after her MFM’s referral but declined that appointment.
Take Home Point:
After I got off the phone with the MFM, I realized that I could have offered a direct consult with the patient. In a subsequent conversation with Dr. Wakefield, the PeriPAN Medical Director, we discussed that I responded to this call with my clinician hat on, so to speak, and that going forward, it would be good for me to develop a PeriPAN hat where I am thinking about training the caller to extend the mental health care they provide their patients with PeriPAN’s assistance.