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A 28-Year-Old Woman, Gravida 1 Para 1, Comes to the Office

question 233

Multiple Choice

A 28-year-old woman, gravida 1 para 1, comes to the office for a postpartum check-up 3 weeks following a cesarean delivery due to cephalopelvic disproportion. She is accompanied by her husband who expresses concern that his wife is crying frequently and having difficulty adjusting to being a new mother. He says, "She was so happy to get pregnant. Apart from the gestational diabetes and having to watch her diet, she was fine through much of the pregnancy. Now, she seems stressed and anxious and not as happy about the baby as I expected." The baby is doing well and had a normal check-up at the pediatrician. The patient describes mild discomfort at the incision site, tension headaches, poor appetite, and fatigue from frequent nighttime awakenings to breastfeed. She says, "I have no energy and feel guilty that I can't even enjoy the baby." The patient spends her time searching the internet for baby care advice but has difficulty remembering what she has read. She worries about the baby's health and fears "I'm a bad mother." Her medical problems include obesity and gastroesophageal reflux. The patient has no past psychiatric history. Family history is significant for alcohol abuse and type 2 diabetes in the patient's father and anxiety disorder in the mother. Physical examination is normal. Hemoglobin is 12.5 g/dL and TSH is 2.1 µU/mL. Her oral glucose tolerance test is within the normal range. Mental status examination reveals a depressed and anxious mood and a tearful affect. The patient has no thoughts of suicide or of harming the baby. Which of the following is the most likely diagnosis?

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Definitions:

Structural Model

A representation that outlines the arrangement and connectivity of components within a system or theory.

Iceberg Model

A metaphor used in psychology and other fields to illustrate that only a small part of a person's mind or situation is visible, while the majority is hidden beneath the surface.

Libido

A term used in psychoanalytic theory to denote the energy associated with sexual drives and desires.

Oedipus Complex

A Freudian theory that suggests a child's unconscious sexual desire for the opposite-sex parent and jealousy toward the same-sex parent.