PeriPAN Case of the Month – January 2024

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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:

26 y/o G5P4 – 3 months PP (not BF) with a hx of miscarriage and Bipolar disorder. Has been off all meds for pregnancy and postpartum. She presents after a DV situation in which partner is arrested. She asks her OB to go back on her meds and wants a referral to psychiatry. 

Reason for PeriPAN Consultation:

The OB has a referral into psychiatry but wants to give her medication now until the appt.  

Explanation of the Case and Outcome of the Call:

She currently reports feeling anxious, depressed and has poor sleep “thoughts racing”. She wants to be a better parent and has an open CPS case. She is irritable with the children. 

She does not have acute AVH, SI. She has a hx of childhood trauma. She has custody of all her children currently. 

Patient reported the last medications she was on that she thought were helpful were venlafaxine, risperdal and trazodone. She did not know the doses.  

Take Home Point:

I suggested she restart Risperdal at a therapeutic dose which could help with sleep, mood, and irritability. Then should wait for assessment for the next step. The psychiatry appt she said is about 3-4 weeks out. 

I suggested risperdal 0.5mg BID for 5 days increase to 1mg BID. 

I also suggested she could give trazodone as prn for insomnia. But would give #14 tabs total.  I suggested PSI support and a therapist. It is unclear if the patient had PTSD or Bipolar or both, but I thought starting with risperdal could help both conditions.  

I let her know to make sure she is not co sleeping with infant on these medications. I did not want to start the venlafaxine without a mood stabilizer.