19-year-old married female with a 2-month-old baby for her 4th visit. Her husband is present today. She presents today dressed more provocatively than you have seen her before. Her makeup is heavier than usual as well. The baby is in a carrier and is sleeping. She immediately starts discussing a video series on aliens she has been watching, her speech is rapid, loud, and tangential. She makes several looseness of associations between the video series and her baby. From her rambling, it sounds as if she believes the baby is an alien and she needs to take it to the desert and leave it on the mountain for the aliens to come and retrieve. She reports making plans to go camping with the baby and her husband this weekend. You question her about suicidal and homicidal ideations and she denies both. The husband states she has been acting “different” for a couple weeks, has never behaved like this before, and he is scared to leave her alone with the baby. She interjects that she knows the secret to world peace and giving their baby back to the aliens will accomplish it. What are your next steps?
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