What is a suitable script for a new psychiatry patient intake for a patient who experienced a stillbirth (intrauterine fetal demise) at 35 weeks of gestation?

From the Guidelines

To provide empathetic and comprehensive care, it's essential to approach the psychiatric intake of a patient who experienced a late fetal loss at 35 weeks with sensitivity and a trauma-informed perspective, prioritizing their comfort and confidentiality throughout the process. When initiating the intake, begin with a gentle and compassionate introduction, such as: "Hello, I'm Dr. [Name]. First, I want to express my sincere condolences for your loss. I understand how difficult this must be, and I appreciate your courage in coming here today. My goal is to provide support and help during this challenging time. Everything we discuss is confidential, and we'll move at a pace that feels comfortable for you" 1.

Psychiatric History

To gather a thorough psychiatric history, use open-ended questions that encourage the patient to share their feelings and experiences without feeling rushed or judged. Questions such as "Could you tell me what brought you here today?" and "How have you been coping since your loss?" can help in understanding their current mental state and how they have been managing their grief. It's also crucial to explore changes in mood, sleep patterns, appetite, and thoughts of self-harm in a sensitive manner, using questions like "Have there been changes in your sleep or appetite?" or "Have you experienced any thoughts of harming yourself?" The Patient Health Questionnaire–9, as discussed in 1, can be a valuable tool in assessing the severity of depressive symptoms.

Reproductive History

When addressing the patient's reproductive history, it's vital to acknowledge the sensitivity of the topic, especially given their recent loss. A gentle approach might involve saying, "I need to ask about your reproductive history, including your recent loss. Please let me know if you need a break at any point." Asking about the pregnancy experience, previous pregnancies, and the circumstances of the loss can provide crucial context for their current emotional state. However, it's essential to allow the patient to guide how much detail they share, respecting their boundaries and offering breaks as needed.

Trauma-Informed Approach

Adopting a trauma-informed approach is critical in this context, as it recognizes the potential for triggers and the importance of creating a safe space for the patient to share their experiences. Validating their feelings with statements like "What you're experiencing is a normal response to a profound loss" can help in building trust and ensuring they feel supported throughout the process. The guidance from 1 on considering the severity of current symptoms, previous mental health history, and patient treatment preferences is also invaluable in making informed decisions about their care.

Comprehensive Care

The interplay between substance use, mental health conditions, and maternal morbidity and mortality, as highlighted in 1, underscores the need for a comprehensive approach to care. This includes screening for substance use and mental health conditions, providing access to evidence-based treatments, and ensuring that the patient's care is coordinated and supportive of their overall well-being. By prioritizing empathy, confidentiality, and a trauma-informed perspective, healthcare providers can offer care that not only addresses the immediate needs of patients who have experienced a late fetal loss but also supports their long-term mental health and well-being.

From the Research

Introduction to the Intake Process

• The patient is greeted with empathy and understanding, acknowledging the recent loss of their fetus at 35 weeks.
• The importance of discussing their psychiatric history and reproductive history is explained, ensuring that all aspects of their care are considered.

Gathering Psychiatric History

• The patient is asked about their previous experiences with mental health conditions, including depression, anxiety, or other psychiatric disorders 2, 3.
• Information about previous treatments, including medications such as selective serotonin reuptake inhibitors (SSRIs), is gathered to understand their effectiveness and potential side effects 4, 5.
• The patient's history of suicidal ideation or attempts is discussed, ensuring that their safety is prioritized throughout the intake process 3.

Reproductive History

• The patient's reproductive history is discussed, including previous pregnancies, miscarriages, or fetal losses 6.
• Information about their current pregnancy, including the circumstances surrounding the fetal loss, is gathered to understand the context of their grief.
• The patient's plans for future pregnancies are discussed, considering the potential impact of their psychiatric history on future reproductive decisions.

Sensitive Inquiry

• The patient is asked about their feelings and emotions surrounding the fetal loss, allowing them to express their grief and emotions.
• The importance of seeking support from family, friends, or support groups is emphasized, ensuring that the patient has a strong support system throughout their care.
• The patient's concerns and questions are addressed, providing them with a sense of control and understanding throughout the intake process.