In a message dated 3/30/2004 12:30:40 PM Eastern Standard Time, [log in to unmask] writes:

> This may not apply at all, but it triggered an association in my head.  I
> just read an article by a mom who experienced postpartum psychosis and one
> of the major descriptors prior to her psychotic break was feeling wired
> all the time, particularly after breastfeeding.  Again, this is probably a
> zebra diagnosis, but I wanted to offer it as a
> consideration.


Psychosis is usually associated with delusions, hallucinations (generally auditory) and/or flight of ideas. Would think flight of ideas can be associated with coming across as "wired," but "feeling wired" can also be associated with a lot of other scenarios, including mental health ones such as anxiety, depression, OCD, etc. and physical ones such as premenstrual dysphoric disorder (PMDD)/PMS. Would think it crucial to do additional assessment. Nonverbal assessment findings/data can also be revealing.

An important aspect for LCs, whose scope of practice wouldn't generally be expected to include this kind of psych-mental health expertise, is to trust if one's antennae go up and are on alert re: "something's not right here"; "two plus two just isn't equalling four with this mom." (Please, NEVER ignore your antennae/intuition/gut -- whatever you call it; you are simply getting assessment data that you just haven't figured out yet.) And then gently but firmly suggest further health assessment by someone with the appropriate expertise.

This is also a good example of why it's important ethically and practically to have mothers sign informed consents that give a LC permission to share findings with mother's primary care provider. The feeling wired in conjunction with an inability to sleep when baby sleeps is often a big tip off re: PP mental health issue, and I think it is almost always a finding that needs immediate sharing with the mother's healthcare provider. If in doubt and/or if antennae buzzing, better safe re: talking to her HCP vs. sorry. (And be sure to carefully document these actions.)

Karen (who possible should mention at this point that her MSN is in adult psych-mental health nursing)

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