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A 38-Year-Old Woman Is Brought to the Emergency Department by Her

question 146

Multiple Choice

A 38-year-old woman is brought to the emergency department by her husband due to depression and difficulty caring for their 3-week-old son. The husband came home from work and found the patient staring at the television and mumbling to herself while the baby cried in his crib in a soiled diaper. He says that she has already lost all her pregnancy weight and frequently cries for no apparent reason. The patient is exhausted because the baby keeps her up all night. She admits to hearing voices sometimes but insists on going home and says, "Everything will be okay if I just get some sleep." The patient has a history of bipolar disorder; she did not take medication during the pregnancy due to concerns about effects on the fetus. On mental status examination, the patient is alert and speaks slowly and softly. Her mood is depressed and her affect is blunted. At one point, she stares into space and mumbles something before turning to the doctor and saying, "I am a terrible mother; I should not have brought a baby into this world." The patient does not have suicidal ideation or intent. Which of the following is the most appropriate course of action?

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