Psychiatric Social Work interventions for Post Partum neurological illness in a Neuro-Casualty and Emergency Setting:...

This study describes a multiple psychosocial problem in a case of a 24-year-old married female, who presented with sudden paraplegia and urinary incontinence, during her post-partum period within 20 days of delivery. She was referred to Neurology casualty and Emergency service by Gynecologist. Patient Presented with acute onset postpartum paraplegia with bowel bladder involvement after delivery of her second child by LSCS (ecamplasia). She was conscious, well oriented, and afebrile. She visited the hospital during COVID-19 pandemic lockdown. However, there was no history suggestive of COVID-19 in the patient. Neurological examination showed complete paraplegia (power 0/5 with decreased tone), associated bowel and bladder involvement with complete sensory deficit below the level of L1 (Lumbar Vertebrae). All necessary blood investigations were carried out. She had anemia. Patient was planned for magnetic resonance imaging (MRI) of Digital Subtraction Angiography (DSA). Patient was initially not agreeing for DSA and denied the same. After counseling she agreed for DSA. Upon clinical and radiological assessment, she was diagnosed with hemorrhagic myelitis. Patient, family members faced crisis and multiple psychosocial problems such as severe psychological distress due to sudden loss of functioning (mobility), feeding the baby in casualty, lack of safe space for the infant in casualty. Persistent worries regarding the future, separation anxiety from the first child owing to hospitalization, worries about risks of infections to the new born baby in the emergency care, and financial constraints were revealed in psychosocial assessment. Patient neurological conditioned remained status quo after three months of follow-up. Psychiatric Social Work team provided following interventions; crisis intervention, psychoeducation and liaison services. The interventions have helped the patient in various psychosocial domains. This case study sensitizes the Psychiatric Social Workers about the importance of psychiatric social work services in perinatal neurology emergency settings.