Case Study: Andrea Yates
Dana Bouchard, Katie Morris, Gentry Scott, and Debbie Wendt
Lakeview College of Nursing
N306B: Holistic Health Promotions
December 6, 2011

Holistic View on Postpartum Psychosis
	Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event, but does occur in 1-2 of every 1000 women. Andrea Yates fell into this statistic. She exhibited many symptoms which suggested this illness. (Massachusetts General Hospital, 2011) Andrea demonstrated abnormal behaviors, which included: delusions, hallucinations, and thoughts of hurting herself and her children. Her illness quickly spiraled out of control. The media was in uproar and this is how America came to know the history of Andrea Yates. 
Patient History
	Andrea Yate’s born in Houston, Texas on July 2, 1964. She graduated in 1986 from the University of Texas School of Nursing in Houston.  After graduation worked as a registered nurse for eight years, in 1993 she was married to Rusty Yates and in 1994 had her first of five children. The Yates family seemed to be your average American family. Andrea assumed responsibility for the children’s education by providing home schooling while Rusty provided financially. It wasn’t until after her fourth child in 1999 she had her first suicide attempt and was admitted into a psychiatric ward. Later discharged and refused to take antidepressant medications. She experienced symptoms of abnormal behavior such as: hallucinations of cameras on the ceiling and characters from television communicating with her.  Eventually started self mutilation and stopped feeding and providing care for children. Her mental state declined further after the death of her father in March of 2000. She stopped talking, refused liquids, and frantically read the Bible. Andrea returned to the hospital seeking care from Dr. Saeed who briefly prescribed her Haldol, but discontinued it because she did not seem psychotic. Released and returned later that May. She was treated for ten days and released and instructed to think positive thoughts and see a psychologist. Two short days later Andrea filled her bathtub up and continuously drowned her five children. After the murders Andrea contacted the authorities stating she had killed her children, which all ironically were named after figures of the Bible. When police entered the Yates home they found four of the children laid beneath a sheet in the back master bedroom. The four children were clothed, soaking wet, and all dead with eyes wide open. The fifth child was found among feces and vomit found floating in the bathtub, dead.  She was then arrested and put to trial. Her controversial trial lasted three weeks and jurors found Andrea Yates guilty for Capital murder. She was not given the death penalty, but sentenced to life imprisonment. Andrea is eligible for parole at the age of 77 in 2041. (Montaldo, 2011)
Primary Nursing Diagnosis
	Andrea suffered postpartum psychosis. An adequate nursing diagnosis would be ineffective coping related to child rearing problems as evidence by hallucinations, attempted suicide, and physical harm to family. (Carpenito-Moyet, 2010)  Postpartum psychosis is caused by a rapid shift in the hormonal environment. In the first forty-eight hours after delivery estrogen and progesterone concentrations fall dramatically. These gonadal steroids aid in the regulation of mood. It appears as an episode of bipolar illness. Earliest signs are restlessness, irritability, and insomnia. Postpartum psychosis is an illness that causes delusional beliefs and auditory hallucinations that instruct mother to harm herself or her infant. Risk for infanticide as well as suicide are significant to this illness. (Ricci & Kyle, 2009)
Traditional Approaches
	Andrea is currently prescribed Lithium 150 mg by mouth three times daily, Tegretol 100mg by mouth three times daily, and a multivitamin tablet once daily. Andrea attends group therapy twice a week as well as individual counseling sessions with her psychotherapist three times a week. She is making good progress, but is having difficulty sleeping. Because of her criminal act against her children Andrea has become anxious and has developed symptoms of obsessive compulsive disorder (OCD).  
Complementary and Alternative Therapy
	According to Fontaine (2011), “meditation is a general term for a wide range of practices that involve relaxing the body and stilling the mind” (p.268). Meditation is affective in calming anxiety and cleans?????.  When practiced on a regular basis, meditation will positively effect  the physical and psychological functioning. “Acupuncture is based on the theory that applying pressure or stimulation to specific points on the body can relieve pain, cure certain illnesses, and promote wellness” (Fontaine, 2011, p. 213).  With stress the flow of energy becomes blocked causing individuals to experience discomfort, irritability on an emotional level, and a lack of purpose in life. Acupuncturists restore the flow of energy by stimulating points along the meridians with hair thin needles. (Fontaine, 2011) “Aromatherapy is the therapeutic use of essential oils of plants to heal the body, mind, and spirit” (Fontaine, 2011, p.145). Oils used during aromatherapy are beneficial to the physiological and psychological systems, by penetrating cell walls and transporting oxygen and nutrients to the cell. Aromatherapy decreases and manages stress, aids in restful sleep, and boost the immune system. 
Conclusion
	In 2006 a jury of six men and six women in Houston, Texas found Andrea not guilty by reason of insanity. She currently resides in a state mental facility where she receives treatment.  With a combination of traditional approaches Andrea is reportedly making progress. (CBS News, 2009) Incorporating complementary and alternative therapies will positively benefit recent symptoms that are not currently controlled with medications. The debilitating illness Andrea suffered from caused her to commit an unforgiveable crime. Proper control of her illness would have provided Andrea with medication and treatment needed to prevent the death of her five children.   

References
Carpenito-Moyet, L. (2010). Nursing diagnosis: Application to clinical practice. Philadelphia, PA: Lippincott Williams & Wilkins.
CBS News (2009). Andrea Yates found not guilty. Retrieved from www.cbsnews.com/stories/2006/07/26/national/main1837248.shtml
Fontaine, K. (2011) Complementary & alternative therapies for nursing practice. (3rd ed.). Upper Saddle River, NJ: Pearson Education, Inc. 
Massachusetts General Hospital (2011). What causes postpartum depression in postpartum psychiatric disorders. Retrieved from www.womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/
Montaldo, C. (2011). Profile of Andrea Yates. Retrieved from crime.about.com/od/current/p/andreayates.htm
Ricci, S. & Kyle, T. (2009) Maternity and pediatric nursing. Philadelphia, PA: Lippincott Williams & Wilkins.