T. I. is a 38-year-old woman who came to our unit, referred from the burns unit of another hospital in Barcelona, with a psychotic condition. The patient suffered burns following a fire at her home which required a month's stay in the unit.
The patient reported no personal or family history of mental illness. She also denied the use of toxic substances. The only somatic antecedents that stood out were: delivery by caesarean section five months ago, infection of the surgical wound, and second and third degree burns from the aforementioned fire.
In the patient's psychobiography, she was from Casablanca (Morocco) and the sixth of nine siblings (five boys and four girls). She attended school until the age of twenty with good performance (school and high school, plus 2 years of complementary education). Her socio-occupational adjustment in her country was good (various temporary jobs as a hostess, shop assistant, sports instructor, etc.). She got married in her country a year and a half ago by family agreement (she had never had a partner or male friends before) and a month later she moved to live in the province of Girona (Spain), where she lived with her husband, her brother-in-law and his wife. Since her marriage, the patient has been a housewife. Her first child (a boy) was born five months ago in a complicated delivery.
Two months ago, a fire broke out in her home in unclear circumstances, which led to her admission to the burns unit of a hospital. On admission to our unit, the patient was vigilant, conscious and temporo-spatially disoriented. Contact with the patient was psychotic; her speech was sparse, in a low voice and with a monotonous tone of voice. She referred to a delirium of prejudice and paranoid delusions that she did not specify. She was suspicious. She reported hypothymia, dysthymia of fear, as well as auditory hallucinations in the form of "noises". The examination revealed a poor fixation memory.
In subsequent interviews with the patient (several of them with the help of a translator), she reported that about two months after the birth she began to experience a mood disorder that oscillated between sadness or crying and elevated mood. She progressively developed delusions of harm towards herself and her child, as well as auditory hallucinations in the form of voices criticising her and giving her orders. In relation to these psychotic symptoms, the patient explained anguish and intense fear of being harmed (herself or her child) as well as her voluntary isolation as a protective measure. On examination in the hours prior to the fire, during the fire and during her stay in the burns unit, the patient explained fluctuations in her level of consciousness and memory loss, so that the suspicion of an extended suicide in the context of the hallucinatory-delusional symptoms could not be ruled out.
During his stay in the acute unit, pharmacological treatment was started with Haloperidol up to 11.5 mg/d (with progressive reduction of the dose), Amisulpride (up to 800 mg/d) and Clonacepam. A few hours after admission she was alert, conscious and oriented. For the first few days the patient was still fearful and suspicious, hardly leaving her room. Slowly, contact, affection and psychotic symptoms improved; the hallucinations gradually disappeared and she gradually distanced herself from the delusional content until she was able to criticise it. He gradually adapted to the dynamics of the unit. Facilitating early and continuous contact with her son and leave from the family home was considered key to the patient's treatment and recovery; in fact, early mother-child contact was an important factor that accelerated the patient's recovery. The leaves were uneventful and the family was very cooperative at all times.
On discharge the patient was euthymic, calm, free of positive psychotic psychopathology and able to take care of her child (although the amnesia secondary to the confusional disorder persisted). The patient and her family raised the possibility of her convalescence in Morocco, which we considered beneficial as she would be cared for by professionals with the same language and culture and would have the support of her family of origin; but we stressed the importance of moving with her son for the transfer to be truly therapeutic.