Psychotic illness following termination of pregnancy

Abstract

A case of a psychotic illness following an induced termination of pregnancy is described; this is discussed in relation to the literature on the subject, and possible aetiological factors in the case are reviewed.

PIP: A case of psychosis occurring 13 days after 1st trimester abortion in a 17-year old primigravida without family history of mental illness of postpartum psychosis is described. The young woman denied any ambivalence or guilt concerning abortion. The abortion itself involved repeat hospitalization for evacuation of retained products, and a course of antibiotics (metronidazole). The illness was marked by insomnia, anorexia, labile mood, auditory hallucinations, inappropriate speech, flat affect, and withdrawal alternating with disinhibition. She was hospitalized 10 days after onset, and treated with neuroleptics (pimozide 4 mg/day). She improved rapidly, and was discharged, taking medication for a few more weeks. After stopping medication she became pregnant, and delivered without any further psychotic symptoms. It is unlikely that metronidazole caused the illness, although it has been associated with confusion, disorientation and hallucinations, because the symptoms occurred 2 days after discontinuing the drug. On the other hand, the patient's flat affect after recovery suggests she might have had incipient schizophrenia.