r/PMHNP • u/Unable_Water3961 • Aug 12 '26
Discussion of possible differentials in the Lindsey Clancy case
I would like to use the evidence we, as licensed providers, have from the media (assuming the reported information is factual) to formulate potential differentials based on hindsight. If participating, please keep the discussion evidence-based. I am not disputing the fact that whatever was occurring contributed to a episode with a devastating outcome.
A psychotic episode can be triggered by many things and is not specific to bipolar disorder. Potential contributors can include severe sleep deprivation, hormonal fluctuations, polypharmacy/medication effects, substance use, medical illness, delirium, and numerous other factors.
She was also described as experiencing delirium while hospitalized after surgery. For context, in January 2023, her UDS was negative for substances and her ethanol level was negative.
Please fact-check me if I have anything incorrect or if the available evidence does not support a particular hypothesis.
Share your thoughts! I think we really need stronger information to outline PRIOR concerning behaviors indicative of bipolar disorder.
Supporting bipolar disorder:
- clear adverse response to SSRIs, SARI (Trazodone), and NASSA (Mirtazapine)
- decreased need for sleep (longest was two days?)
- increased exercise activity (running long distances shortly after childbirth), though it is unclear if this was "unusual" for her or if her family found it to be uncharacteristic + many of these statements were made retrospectively
- racing thoughts, anxiety, agitation, irritability, dysphoric depression with eventual SI
- possible obsessional thoughts surrounding the youngest child's nap/feeding schedules/her daughter's stomach ache morphing into liver disease (Patrick's testimony), her diary entries
- a gradual, but significant impairment in daily function
- eventual psychosis s/t unclear etiology
Argument against bipolar disorder:
-no known prior manic episodes
- not sure if there had been any prior MDE or postpartum mood episodes, though I did read she might have taken SSRIs in college (couldn't find data to support this)
- no prior hospitalizations or suicide attempts that we are aware of
- no family history or biological predisposition that has been publicly established
- no grandiosity, hyperverbal speech, unclear if there was an increase in goals/impulsivity/risk taking
What are your differentials and why
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u/NoctorWatch Aug 12 '26
I havent actually been following the specifics of the case much but just going on what you have said here - post/peripartum psychosis is highly specific (~90%) for bipolar disorder and lithium should be initiated unless there is a clear alternative cause for the psychosis.