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Pregnancy and Lactation
Instructions: Case Discussion on Treatment of Prescribing Recommendations for Pregnant and Lactating Women:
A 22-year-old pregnant woman (18 weeks AOG) presented with 7 years of heavy intravenous heroin dependence on top of her daily methadone dose. She manifested with complicated pregnancy (bleeding and abdominal pain), heroin-related medical problems (abscesses, cellulitis), and severe craving as well as other psychosocial related issues namely homelessness, court case, poor family support, and unemployment.
When intoxicated, she describes her mood as “really good”. When she does not use, she craves for the drug, becomes very sick, sleepy, feels depressed, and has a large appetite. She has tried to quit on numerous occasions, even entering an inpatient treatment program at one point, but she always quickly begins using again. The patient used to work part-time as a secretary, but she lost her job as she was chronically late and, in fact, stole money in order to pay her dealer. She freely admits that she was trying to rob the grocery store to “pay off my debts.”
• Summarize the clinical case.
• Create a list of the patient’s problems and prioritize them.
• Which diagnosis or diagnoses should be considered
• What is your rationale for the diagnosis or diagnoses
• What differential diagnosis should be considered
• What test or screening tools should be considered to help identify the correct diagnosis or diagnoses
• What treatment would you prescribe and what is the rationale (Consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
• What standard guidelines would you use to assess or treat this patient
Sample Answer
Summary of Clinical Case
A 22-year-old pregnant woman (18 weeks) struggles with severe heroin dependence for 7 years. She experiences complicated pregnancy issues, heroin-related medical problems, and strong cravings. Additionally, she faces homelessness, legal issues, lack of family support, and unemployment. She describes feeling good when intoxicated but experiences withdrawal symptoms, depression, and intense cravings when not using. Past attempts at quitting, including inpatient treatment, were unsuccessful.
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