Psychiatric manifestations preceding fetal death in antiphospholipid syndrome

Objectives: Antiphosholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of thrombotic events, pregnancy morbidity and antiphospholipid antibodies. The objective of this report is to sensitize mental health professionals to the psychiatric manifestations of APS during pregnancy. To our knowledge, this is the first report on this matter. Case summary: A 34-year-old pregnant woman, with no previous medical, obstetrical or psychiatric history, at the 18th week of pregnancy, acutely developed depressed mood, feelings of anxiety and insomnia with a strong premonition that "the fetus would die." Actual fetal loss ensued a few days later. During induced labor, the patient had an agitated delirium. Symptoms of depression, slowed mentation and apprehension persisted for at least 2 months after fetal demise and required pharmacological treatment. APS diagnosis was established based on clinical events and persistent findings of antiphosholipid antibodies as well as multiple high-density foci in the subcortical white matter of the frontal lobes in brain magnetic resonance imaging. Conclusions: Psychiatric symptomatology, as well as a premonitory sense of upcoming loss of pregnancy, preceded actual fetal loss and APS diagnosis in the presented case, indicating that psychiatric symptoms may present during pregnancy, perhaps as an early sign. (C) 2010 Elsevier Inc. All rights reserved.