Magazine article Clinical Psychiatry News

Treating Schizophrenia during Pregnancy

Magazine article Clinical Psychiatry News

Treating Schizophrenia during Pregnancy

Article excerpt

Pregnancy is a time of heightened vulnerability for women with schizophrenia and their offspring.

Compared with women who are not mentally ill, those with schizophrenia have more unwanted sex and pregnancies, less prenatal care, a greater risk of being a victim of violence during pregnancy, and a reduced likelihood of having a partner. These disadvantages in social context compound the risks from direct effects of the illness.

This month, CLINICAL PSYCHLATRY NEWS talks with Dr. Laura Miller about inpatient work with women who have schizophrenia and are pregnant. Dr. Miller, an expert in women's mental health, runs a perinatal mental health project in Illinois.

CPN: What are the key risks of pregnancy and the postpartum period in women with schizophrenia?

Dr. Miller: During pregnancy, key risks include delayed recognition of pregnancy, less prenatal care, failure to recognize labor, and a greater incidence of obstetric complications. A particularly high-risk symptom is psychotic denial of pregnancy, a condition in which the woman denies that she is pregnant despite clear indications, and thereby refuses prenatal care, misinterprets signs of labor, risks precipitous and unassisted delivery, and fails to bond with the baby.

The postpartum period is a time of increased risk for exacerbation of schizophrenia. Symptoms and sequelae of schizophrenia can also adversely affect parenting capability, which leads to high rates of custody loss. At times, delusions and/or hallucinations about the baby directly interfere with bonding and parenting.

Negative symptoms of schizophrenia, such as apathy or difficulty expressing emotions, may contribute to under stimulation or neglect of a baby. The additional risks of obstetric complications and parenting difficulties for offspring who may be genetically vulnerable further heightens the long-term risk of psychiatric morbidity in the children of women with schizophrenia.

CPN: What can psychiatrists treating inpatients do to help these patients?

Dr. Miller: Proactive interventions can greatly reduce risks. When women with schizophrenia require hospitalization during pregnancy, there is a unique opportunity to implement comprehensive risk reduction strategies that promote a healthy pregnancy, delivery, postpartum period, and parenting experience. This first step is a comprehensive assessment.

CPN: How do you assess women with schizophrenia who are pregnant?

Dr. Miller: First, it is important to assess the patient for delusions about the pregnancy or the fetus, including psychotic denial of pregnancy. The patient should then be evaluated for her understanding of the normal bodily changes of pregnancy, labor, and delivery--with identification of gaps in knowledge.

After that, it is important to identify comorbidities that could increase the risk of adverse obstetric outcome, including substance addiction and HIV infection.

Although parenting capability cannot be comprehensively assessed during pregnancy, inpatient clinicians can identify parenting strengths and weaknesses, as well as the specific effects of symptoms on parenting attitudes and behaviors.

CPN: What kind of treatment plan works best for these patients?

Dr. Miller: An optimal treatment plan includes medication and psychoeducation. …

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