Chapter 30
Wojewódzki Szpital dla Nerwowo i Psychicznie Chorych w Lubi??u
(Voivodeship Hospital for Nervous and Mentally Ill in Lubi??)
Psychiatric Inpatient Record - Closed Ward
(Translated from original Polish documentation)
Patient Name: Magdalena [Surname redacted]
Age: 24 years
Sex: Female
Gestational Age: Approx. 32–34 weeks
Mode of Admission: Emergency admission following suicide attempt
Legal Status: Involuntary admission under psychiatric hold
Reason for Admission
Patient admitted following a suicide attempt and ongoing risk of harm to self and unborn child.
Prior to admission, patient reportedly engaged in repeated attempts to terminate pregnancy through self-inflicted means, resulting in multiple internal injuries requiring gynecological evaluation.
Initial Presentation
Upon arrival, patient was highly agitated, disorganized, and resistant to examination.
Observed:
Loud, pressured speech
Episodes of screaming and crying
Rapid shifts between agitation and withdrawal
Refusal of physical contact, followed by sudden aggressive outbursts
Patient required physical and pharmacological restraint upon admission due to risk posed to herself and staff.
Mental Status Examination
Appearance: Disheveled, poor self-care
Behavior: Severely agitated, unpredictable, occasionally aggressive
Speech: Pressured, incoherent at times
Mood: Labile (rapidly shifting), predominantly fearful and distressed
Affect: Intense, unstable
Thought Process: Disorganized, tangential
Thought Content:
Fixed delusional belief that the fetus is “the devil”
Expressed conviction that the child intends to kill her
Recurrent statements indicating need to “destroy it before it is born”
Perception: Possible auditory hallucinations (patient observed responding to internal stimuli)
Insight: Absent
Judgment: Severely impaired
Risk Assessment
High risk of self-harm: Confirmed by recent suicide attempt
High risk to fetus: Ongoing intent to harm pregnancy
Risk to others: Patient demonstrates unpredictable aggression and paranoid ideation
Patient assessed as severely mentally unstable and dangerous without supervision.
Physical / Obstetric Findings
Patient in late-stage pregnancy
Evidence of prior self-inflicted trauma requiring ongoing monitoring
Obstetric consultation requested immediately upon admission
Clinical Impression
Presentation consistent with:
Acute psychotic episode with severe paranoid and delusional features
Possible peripartum (antenatal) psychosis
Differential diagnosis includes bipolar disorder (manic episode with psychotic features)
Condition considered psychiatric emergency.
Treatment Plan
Immediate Measures:
Admission to closed psychiatric ward with constant observation (1:1 supervision)
Removal of all potentially harmful objects
Use of restraints only as necessary for safety
Pharmacological Treatment:
Initiation of antipsychotic medication (e.g., Haloperidol – dose adjusted)
Sedative support (e.g., Diazepam) for acute agitation
Close monitoring for effects on pregnancy
Psychiatric Management:
Daily psychiatric evaluation
Stabilization of psychotic symptoms as primary goal
Gradual reduction of agitation and paranoid ideation
Obstetric Care:
Ongoing fetal monitoring
Coordination with obstetrics team regarding risks and delivery planning
Safety Measures:
Continuous supervision due to persistent risk
Staff instructed on high-risk behavioral profile
Prognosis
Guarded.
Stabilization possible with intensive psychiatric treatment; however, current condition represents severe and acute mental disturbance requiring prolonged inpatient care.
Attending Staff
Attending Psychiatrist: Dr. El?bieta Kamińska
Ward Nurse: Maria Zielińska, RN
Wojewódzki Szpital dla Nerwowo i Psychicznie Chorych w Lubi??u
(Voivodeship Hospital for Nervous and Mentally Ill in Lubi??)
Psychiatric Discharge Summary (Epikrisis)
(Translated from original Polish documentation)
Patient Name: Magdalena [Surname redacted]
Age: 25 years
Sex: Female
Reason for Admission
Patient was admitted to the closed psychiatric ward in late-stage pregnancy following a suicide attempt and presentation of acute psychotic symptoms, including severe paranoid and delusional beliefs concerning the fetus, accompanied by a high risk of self-harm.
Course of Hospitalization
At the time of admission, the patient presented in a severely disturbed mental state, characterized by agitation, emotional instability, and fixed delusional thinking. She required close supervision and pharmacological intervention.
Throughout the course of hospitalization, the patient received intensive psychiatric treatment, including antipsychotic medication and supportive care.
A gradual and sustained improvement in mental state was observed:
Resolution of acute psychotic symptoms
Stabilization of mood and behavior
Increased cooperation with medical staff
Partial restoration of insight
Obstetric Course
During hospitalization, the patient gave birth to a live infant. Due to her psychiatric condition at the time, caregiving responsibility was transferred to the child’s father.
The child has remained in the father’s care in a stable environment since birth.
Mental Status at Discharge
At the time of discharge, the patient is:
Calm and cooperative
Oriented and coherent in thought and speech
Free of active delusions or hallucinations
Demonstrating improved, though still partial, insight
No current suicidal ideation reported.
Diagnosis
Acute psychotic disorder associated with pregnancy (peripartum psychosis), currently in remission under treatment
Treatment and Recommendations
Medication:
Continuation of prescribed antipsychotic treatment is essential. Compliance is critical to maintaining stability.
Follow Up Care:
Regular outpatient psychiatric follow-up is required, with close monitoring of mental state and treatment adherence.
Living Situation:
Patient is discharged to reside with the child’s father and infant. The home environment has been assessed as stable and supportive.
Supervision:
Family members have been instructed to observe for any signs of relapse, including:
Return of paranoid or delusional thinking
Behavioral instability
Withdrawal or agitation
Immediate psychiatric consultation is advised if symptoms recur.
Risk Assessment
At the time of discharge:
Risk of self-harm: Low (conditional on treatment adherence)
Risk of relapse: Moderate
Risk to others: Low
Conclusion
The patient is considered psychiatrically stabilized and suitable for discharge under structured outpatient care and family supervision.
Continued treatment compliance is essential for maintaining remission.
Attending Staff
Attending Psychiatrist: Dr. El?bieta Kamińska
Ward Nurse: Katarzyna Wójcik, RN
Komenda Miejska Policji we Wroc?awiu
(Municipal Police Headquarters in Wroc?aw)
Missing Persons Report / Incident Report
(Translated from original Polish documentation)
Case Number: KMP-WR/MP/0412/97
Date of Report: [Filed same day as incident]
Reporting Officer: Sgt. Piotr Zieliński
Reporting Party
Name: Tomasz [Surname redacted]
Age: 28 years
Address: [Redacted – Wroc?aw]
Relation to Missing Persons: Father of minor child / cohabitant of adult female
Missing Persons
1. Magdalena [Surname redacted]
Age: 26 years
Sex: Female
Description: Thin build, pale complexion, dark hair (shoulder length)
Medical Background: Documented history of psychiatric hospitalization, including psychotic episodes
2. Child (Name Redacted)
Age: Approximately 18 months
Sex: Male
Description: Infant/toddler, dark hair
Statement of Reporting Party
Reporting party states that during nighttime hours, Magdalena left the shared residence without notice, taking the child with her.
He reports that both individuals were present in the residence earlier in the evening. At approximately 06:30, he awoke to find them missing. No note or indication of destination was left behind.
The reporting party emphasizes extreme concern for the safety of the child, citing the mother’s psychiatric history.
According to his statement:
The mother has previously been hospitalized for severe psychotic episodes
During pregnancy, she expressed fixed delusional beliefs that the child was “the devil”
She made documented attempts to harm the unborn child
Although stabilized following treatment, he reports ongoing concern regarding her mental state
The reporting party further states:
He and Magdalena are not in a romantic relationship
He allowed her to reside in his apartment in order to:
Provide stability for her
Ensure safety of their child
Fulfill his parental responsibilities
He describes her recent behavior as withdrawn and increasingly tense, though no direct threats were made prior to the incident.
Assessment
Due to:
Prior history of severe psychiatric disturbance with delusional content involving the child
Documented risk of harm during pregnancy
Sudden, unannounced departure during nighttime hours
This case is classified as high-risk missing persons (child endangerment concern)
Actions Taken
Immediate missing persons report filed
Case entered into national police system
Patrol units notified and instructed to conduct area search
Alert issued to nearby jurisdictions
Hospitals and emergency services notified
A formal search operation has been initiated.
Additional Notes
No evidence of forced entry or third-party involvement at residence.
Investigation ongoing.
Reporting Officer
Sgt. Piotr Zieliński
Komenda Miejska Policji we Wroc?awiu