Antipsychotic Medication Ebooks Catalog

The Schizophrenia-free Package

What are you going to find in the Schizophrenia-FreeYour New Life Begins Today e-book: Relationships and Friends: In this chapter, I share with you my way of thinking about friends and relationships. I provide my point of view about how I see this interesting issue. I also give you some tips about how to get friends, deal with friends, and treat relationships. About Schizophrenia and Getting Well: In this chapter, I describe my way of thinking about schizophrenia and other similar mental illnesses. Living on Your Own and Being Independent: In this chapter, I share my perspective about our independence as sufferers and how to live on our own and be independent. Other Sufferers' Recovery Examples: I decided to share other sufferers' stories so you won't feel alone in your illness. Finding Your Mate and Getting Married: Having a mate is one of the most important pillars in your life as a sufferer. In this chapter, you learn some of the most important basics in this matter. Preventing Future Seizures and Getting Help: This chapter shows how to reduce the chance of having future psychotic disorder seizures and, even if you experience one, how to make it as minimal as possible. Dieting and Exercising: This chapter demonstrates how to acquire easy life habits in order to survive your years to come in the healthiest manner possible. Living by Yourself and Earning Your Own Money: This chapter shows how to earn your own money and live by yourself as a result. Ways of Getting Support: There is nothing like a good support system in order to rehabilitate in the best matter possible. This chapter discusses the most basic and powerful ways of getting support. Quitting Smoking: In this chapter, you learn the basic principles of why and how to quit smoking. Learning a Profession and Finding a Job: In this chapter, you learn the most important factors for learning a profession and finding a job.

The Schizophreniafree Package Summary


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2 Antenatal Needs Of Women With Schizophrenia

Fertility is lower among women with schizophrenia than in the general population, but this may change with the widespread use of the newer antipsychotics that do not raise prolactin levels and, thus, do not interfere with conception (7). In a recent publication from Finland that looked at fertility rates of 870,093 individuals born in that country in the 1950s, 1.3 was reported to be patients with schizophrenia. These individuals would still have been treated with first-generation drugs. The mean number of offspring among the patients was 0.83 for women and 0.44 for men, compared with 1.83 and 1.65 among women and men in the general population (8). In preparation for a healthy pregnancy and optimal mothering, women of childbearing age with a severe, ongoing illness such as schizophrenia require more than standard psychiatric care. They need support and training in many important areas often lacking in even the most comprehensive rehabilitation programs, such as health promotion,...

8 Antipsychotic Medications In Pregnancy

Generally required in pregnancy than in the nonpregnant state in order to achieve therapeutic serum levels. On the other hand, progressively greater levels of estrogen augment dopamine receptor blockade in the brain so that, for many women with schizophrenia, actual doses needed in order to keep symptoms at bay during pregnancy may be lower than were required in the nonpregnant stage (17).

11 Services Required For Women With Schizophrenia During Childbearing Years

There is a need for integrated services that can provide antenatal, pregnancy, and postpartum comprehensive care to women with schizophrenia. When the child is born, these women can benefit from home visitors who focus on enhancing the mother's responsiveness to infant cues (although home visitors are not always welcome) (56). Parent coaching teaches mothers how to play with their infants and helps them to respond in a soothing way to an infant in distress. Such interventions enhance a mother's feeling of effectiveness and demonstrate good infant outcomes (57). A multisystemic approach works well with high-risk families (58). This approach uses a variety oftreatments, including family therapy, parent coaching, supportive therapy for the mother, social skills training, and case management and advocacy. The first stage of intervention includes an assessment of the risk, protective factors, and identified needs of the family in order to choose the most suitable interventions. Ongoing...

Baby blues postnatal depression and postpartum psychosis complicated reactions to having a baby

Therefore, it can be helpful to think of three types of reaction after having a baby that do need to be distinguished from each other. The first is 'baby blues', the second, is post-natal depression, and the third is postpartum or puerperal psychosis. Post-natal depression (PND) will be covered in the next chapter, as it would not be an appropriate way to describe someone's initial emotional response to having a baby. PND develops more gradually over time. Baby blues and puerperal psychosis are usually seen in those early days. In looking at the statistics it is clear that baby blues is extremely common, PND is experienced by about one in ten women and puerperal psychosis by only about one in every thousand new mothers.

Puerperal or postpartum psychosis

Very few books on pregnancy and childbirth will have a section on puerperal psychosis.This is possibly because it is so rare, affecting only around 1 2 mothers in every thousand. Probably there is a feeling that discussing it might frighten prospective mothers unnecessarily. There used to be a similar attitude to post-natal depression that it was best not mentioned to mothers. This leaves problems somewhat shrouded in mystery and women who do have these problems are left to feel shameful about what has happened.

So what is puerperal psychosis

The term psychosis is used to describe illnesses that are made up of delusions, hallucinations and often extreme paranoia. The symptoms in puerperal psychoses tend to be like those of manic-depression and more rarely schizophrenia. Alternatively the mother may just present as very depressed and unresponsive. Again it is important to emphasise that puerperal psychosis is extremely rare. If the mother has a history of serious mental illness, then both staff and family may have been alerted to the possibility of these problems in pregnancy.

7 Relationship Between Postpartum Psychosis And Bipolar Affective Disorder

Many researchers believe that postpartum psychosis is either a variant or a manifestation of a manic mixed episode and in many women demarcates the onset of bipolar disorder (110,120,121). Postpartum psychosis is a rare condition affecting 0.1-0.2 of all women experiencing childbirth (110,122). Women with bipolar disorder have a significantly higher risk than women without a psychiatric disorder of developing postpartum psychosis (5,12,17,18,104-108,123). Recent studies have found that for women with bipolar disorder, the risk of developing postpartum psychosis is increased to 20-50 , particularly when mood-stabilizing medications (i.e., lithium) are discontinued during pregnancy and not reinstated within 48 h of delivery (5,110,116,122). Furthermore, additional research has demonstrated that many women with postpartum psychosis will later develop bipolar disorder (7,12,17,104-108,111,124-128). One study found that one-third of 486 women admitted psychiatri-cally with postpartum...

Postpartum Psychosis

Puerperal psychosis, the most severe form of postpartum psychiatric illness, is a rare event that occurs in about 1-2 per 1,000 women after childbirth (Brockington et al. 1982 Kendell et al. 1987). Its presentation is often dramatic, with onset of symptoms as early as the first 48-72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first 2 postpartum weeks (Brockington et al. 1981 Dean and Kendell 1981). Longitudinal studies indicate that most women with postpar-tum psychosis have an affective illness, most commonly bipolar disorder (Chaudron and Pies 2003 Dean et al. 1989). The symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic or mixed episode (Brockington et al. 1981 Dean and Kendell 1981). The earliest signs are restlessness, agitation, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and disorganized behavior....

12 Development and health

The care of pregnant women presents one of the paradoxes of modern medicine. Women usually require little medical intervention during an (uneventful) pregnancy. Conversely, those at high risk of damage to their own health, or that of their unborn, require the assistance of appropriate medicinal technology, including drugs. Accordingly, there are two classes of pregnant women the larger group requires support but little intervention, while the other requires the full range of diagnostic and therapeutic measures applied in any other branch of mcdicine (Chamberlain 1991). Maternal illness demands treatment tolerated by the unborn. However, a normal pregnancy needs to avoid harmful drugs - both prescribed and over-the-counter, and drugs of abuse, including cigarettes and alcohol - as well as occupational and environmental exposure to potentially harmful chemicals. Obviously, sufficient and wcll-balanced nutrition is also essential. Currently, this set of positive preventive measures is by...

13 The Differential Diagnosis

Once a postpartum woman has been identified as suffering from a mood disturbance, determining the nature, timing of onset, duration, and severity ofthe symptoms is essential to making a correct diagnosis (Table 1). The differential diagnosis ranges from normal adjustment and the baby blues to anxiety disorders, PPD, postpartum psychosis, and or bipolar disorder. Characteristics of the Baby Blues, Postpartum Depression (PPD), and Postpartum Psychosis Sorting Through the Differential Diagnosis Postpartum psychosis PPD, although also quite common (10-15 of postpartum women), results in distress and impairment in function that can linger well into the first postnatal year if not treated (24). The diagnosis of PPD is made using the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for MDD. If the symptoms occur within the first 4 wk after delivery, an additional specifier, with postpartum onset, may be added to the MDD diagnosis. Although the...

Prevalence of Mood and Anxiety Disorders During Pregnancy

Whereas certain psychiatric disorders may be readily detected during pregnancy (e.g., psychosis, panic disorder), depression that emerges during pregnancy is frequently overlooked. Many of the neurovegetative signs and symptoms characteristic of major and subsyndromal depression (e.g., disturbance in sleep and appetite, diminished libido, fatigue) are also observed in nondepressed women during pregnancy. In addition, certain medical disorders commonly seen during pregnancy, such as

2 Biological Underpinnings Of Postpartum Mood Disorders

Estradiol may enhance postsynaptic dopamine receptor sensitivity, increasing risk for postpartum psychosis or mood instability Twelve women with postpartum psychosis and low serum estradiol levels were successfully treated with estradiol 23 women with PPD and low serum estradiol improved as treatment with estradiol increased serum estradiol to follicular phase levels PPD and psychosis in hypogonadal postpartum women may be responsive to treatment with estradiol supports notion that hypogonadism contributes to symptom onset p The Hypothalamic-Pituitary-Adrenal Axis in the Pathogenesis of Postpartum Depression (PPD) or Psychosis The Hypothalamic-Pituitary-Adrenal Axis in the Pathogenesis of Postpartum Depression (PPD) or Psychosis No association between Cortisol levels and postpartum psychosis No evidence that Cortisol levels or degree of suppression by dexamethasone is involved in postpartum psychosis No evidence that cortisol levels or degree of suppression by dexamethasone is...

2116 Phenothiazines and thioxanthenes

Phenothiazines are effective in the treatment of psychosis and of hyperemesis, as they also block histamine receptors. They readily cross the placenta elimination is much slower by the fetus and the neonate than by adults. Chlorpromazine is the prototype of phenothiazines, and is structurally related to promethazine, which is used as an antihistamine. Phenothiazines block the dopamine receptors in the basal ganglia, the hypothalamus, and the limbic system. Due to their effect on dopamine metabolism, they may cause extrapyramidal effects. Phenothiazines also have antiemetic and antiallergic properties (see Chapters 2,2 and 2.4). Data on use during pregnancy are available for alimemazine, chlorpromazine, dixyrazine, fluphenazine, levomepromazine, pericyazine, perphenazine, prochlorperazine, promazine, thioridazine, trifluoperazine, and triflupromazine. The data on pregnancy outcome are conflicting. Case reports of malformations have been reported (e.g. microcephaly, syndactyly, cardiac...

33 Antipsychotic Agents

The effects of using antipsychotic medications on women with bipolar disorder and on infant outcome have not been well studied. Data regarding fetal outcome using antispychotics have been best studied in the condition ofhyperemesis gravidarum using such antipsychotics as chlorpromazine (54,55). In a survey of more than 50,000 mother-child pairs that identified 142 first-trimester exposures to chlorpromazine, there was no elevation in the rate of physical malformations in those children exposed to chlorpromazine (55). To our knowledge, no systematic studies regarding the use of typical antipsychotics in women with bipolar disorder have been reported. One study involving schizophrenic women on typical antipsychotic medication in pregnancy suggested that psychiatric illness (psychosis) may influence pregnancy outcomes more than antipsychotic medication. Sobel compared psychotic women with and without histories of chlorpromazine exposure during pregnancy (56). The...

Fetal Risk Summary

No human reports associating the use of beclomethasone with human congenital anomalies have been found. A 1975 report briefly mentioned seven healthy babies born from mothers who had used beclomethasone aerosol for over 6 months (4). In another report, beclomethasone was used during 45 pregnancies in 40 women (5). Dosage ranged between 4 and 16 inhalations day (mean 9.5), with each inhalation delivering 42mg of drug. Three of the 33 prospectively studied pregnancies ended in abortion that was not thought to be caused by the maternal asthma. Forty-three living infants resulted from the remaining 42 pregnancies. Six infants had low birth weights, including two of the three premature newborns (less than 37 weeks' gestation). There was no evidence of neonatal adrenal insufficiency. One full-term infant had cardiac malformations (double ventricular septal defect, patent ductus arteriosus, and subaortic stenosis). However, the mother's asthma was also treated with prednisone, theophylline,...

11 Treatment Guidelines

No consensus exists regarding the most suitable time to reintroduce prophylaxis (117,119). The most prudent plan is to use medication(s) to which the individual woman has previously responded well and to prepare a plan for rapid augmentation if breakthrough episodes of hypoma-nia or depression or mixed eipsodes occur during the immediate postpartum period (115). It is well known that women with bipolar disorder who discontinue lithium prior to pregnancy and have remained well during the pregnancy are at significantly increased risk of relapse, which may take the form of manic psychosis or a major depressive episode, within the first month postpartum (174). Although some authors suggest reinstituting mood stabilizers in the second or third trimester of pregnancy when the teratogenic risk is lower, many patients may prefer to defer prophylaxis until immediately after delivery (117). Particularly vulnerable women may require treatment throughout their pregnancies.

3 Course Of Illness In Pregnancy

Most pregnant women with schizophrenia are single and live in poverty, often in poor housing, often estranged from their immediate and extended families (16). Severity of illness over the course of pregnancy varies. It is not known whether changes associated with pregnancy and lactation significantly alter the course of schizophrenia symptoms. For women with chronic severe psychiatric illness across diagnoses, there is a slight but significant reduction in rates of contact with psychiatric services and admissions during pregnancy compared with periods before and after childbirth (17). Although many women experience a lessening of symptoms, some become more delusional, deny the pregnancy, and may try to harm the fetus (18). About 25 of pregnancies are electively terminated in this population (4).

4 Risks Of Untreated Illness To Mother And Fetus

Becoming a mother is important to most women with schizophrenia (19), and this may paradoxically lead to an abrupt discontinuation of medication, motivated by the wish to not harm the fetus. Subsequent exacerbation of illness may lead to poor self-care and a failure to stay involved with health care providers and family members. Women with schizophrenia face the stigma associated with their diagnosis their families, their caregivers, and their communities do not approve of them bearing children. Denial of pregnancy (18) may be a way for psychotic women to deal with that perception a self-defeating strategy that deprives the pregnant woman of much-needed prenatal care.

Your baby arrives at last

In this chapter we will look at what might happen in those first few days. What are the immediate tasks of parenting how often should I feed the baby How long will he sleep for Should I pick him up when he cries Is this something that we learn or that comes instinctively Second, the mother has to recover from the labour. You may have stitches, a catheter, bruising and discomfort and most likely you will feel exhausted. There can be a roller coaster of emotions too. Most women initially are on something of a high they are immensely relieved the baby has arrived and appears well, the pains and emotions of labour have disappeared and they are sharing those first few moments with their baby. This, however, can very suddenly be replaced by tears, frustration and uncertainty as the reality of caring for the baby dawns and your tiredness and discomfort kick in.We will consider the emotional situation of those first few days looking at the range of reactions such as 'baby blues' through to...

6 Course Of Illness Postpartum

Of women with schizophrenia, 16 are hospitalized with a postpartum psychosis within 6 mo of giving birth (4). The mechanism by which childbirth precipitates a psychosis may be related to the sudden drop of sex steroids following labor, but studies remain inconclusive. It has been suggested that dopaminergic transmission is increased by postpartum estrogen withdrawal (23). This is an argument for raising the dose of antipsychotic medication after delivery, but the threat of custody loss can paradoxically make these women stay away from their health care providers and stop taking their medications, either because they are afraid they will not hear their infant crying at night or because they think medication use precludes breast-feeding. Strategies for the prevention and clinical management ofpostpartum exacerbations include early identification of women at risk close monitoring throughout pregnancy, support and child-care assistance, prompt recognition of impending psychosis, and...

9 Antipsychotic Effects On Pregnancy Outcomes

No medication regimen can be considered completely safe during pregnancy. By the same token, the added risk is often minimal and far smaller than the risk of the mother going untreated. Women with schizophrenia have been found to be at relatively increased risk for poor obstetrical outcomes, including preterm delivery, LBW, and neonates who are small for their gestational age (40). This may, in part, be the effect of medications but is, to a large extent, attributable to these women's relative lack of prenatal care, poor nutrition, alcohol, nicotine, and drug use, higher body mass index, poverty, and general lack of self-care.

5 Maternal Marijuana

In recent years, the concentration of the major psychopharmaco-logically active component of cannabis, tetrahydrocannabinol (THC), has increased, as have reports of adverse effects. The increase in THC is a result of plant selection and cultivation changes (38). Short-term adverse effects of marijuana use include memory and learning problems, distorted perception, and difficulty with problem solving. Psychiatric symptoms associated with marijuana use include anxiety, depression, paranoia, and psychosis (39,40).

What about the future

Recovery for women with a post-natal psychosis is generally better than for someone experiencing a non-birth-related psychotic illness. However, hospital admissions will run into a number of weeks or months. The prognosis is better where you have only had a psychosis once following childbirth and you have no family history of similar psychiatric problems.With regard to further problems, there is probably around a 1-in-5 chance of this happening again in subsequent pregnancies and the risk is higher if you have had a psychotic illness before. For all women, however, careful support and monitoring are recommended around any future pregnancies.

7 Maternal Methamphetamine

Methamphetamine is a derivative of amphetamine. It can be ingested, snorted, smoked, or used intravenously. Because its duration of action lasts 6-8 h, users tend to use it once or twice a day (62). Common street names include speed, meth, tweek, chalk, ice, crystal, and glass. Meth-amphetamine is a potent stimulant, and its effects include increased confidence, wakefulness, and physical activity, as well as euphoria and decreased appetite. Other signs of use include pupil dilation, constant talking, tooth grinding, sweating, and irritability. Chronic, long-term use can cause insomnia, increased blood pressure, paranoia, psychosis, aggression, and mood lability. The toxic effects of methamphetamine include seizures, heart attacks, and strokes (63). Health care providers should be aware that methamphetamine-dependent individuals report a high incidence of domestic and interpersonal violence, which may impact the welfare of the mother and the child (64).

History of Affective Disorders

There is a well-defined association between all types of postpar-tum psychiatric illness and a personal history of affective disorder. At highest risk are women with a history of postpartum psychosis it is estimated that up to 70 of women who have had one episode of puerperal psychosis will experience another episode following a subsequent pregnancy (Davidson and Robertson 1985 Garfield et al. 2004 Kendell et al. 1987). Similarly, women with histories of PPD are at significant risk, with rates of postpartum recurrence as high as 50 (Garfield et al. 2004). Women with bipolar disorder also appear to be particularly vulnerable during the postpartum period, with rates of postpartum relapse ranging from 30 to 50 (Nonacs et al. 1999 Reich and Winokur 1970 Viguera et al. 2000). This population is also at increased risk of postpartum psychosis (Reich and Winokur 1970). The extent to which a history of unipolar depression influences risk for postpartum illness is less clear. Although studies...

Hormonal Interventions

There is some evidence to suggest that estrogen has beneficial effects in women with postpartum psychiatric illness. Gregoire and colleagues (1996) described the benefit of transdermal estra-diol-17p (200 g daily) in a double-blind, placebo-controlled study of women with PPD. At 12 weeks, 80 of the women receiving estrogen (n 37) were no longer depressed (scoring < 14 on the EPDS), compared with 31 in the placebo group (n 24). Although this study was small and was confounded by the inclusion of patients who were concurrently treated with antidepres-sant medication, it is the first to demonstrate that estrogen alone (or possibly when used as an adjunct to an antidepressant) may be useful in the treatment of postpartum depression. More recently, Ahokas and colleagues (2001) used sublingual estradiol-17p as monotherapy in an open-label study of 23 women with PPD. In this study, 19 of 23 women experienced recovery after 2 weeks of treatment with estradiol. A similar study from the same...

Prophylactic Interventions

Several studies have demonstrated that women with histories of puerperal psychosis benefit from prophylactic treatment with lithium instituted either prior to delivery (at 36 weeks' gestation) or no later than the first 48 hours postpartum (Austin 1992 Stewart 1988 Stewart et al. 1991). Lithium prophylaxis is also effective for women with histories of bipolar disorder it appears to significantly reduce relapse rates, as well as to diminish the severity and duration of puerperal illness (Cohen et al. 1993 Viguera et al. 2000). In a retrospective study including 27 pregnant women with bipolar disorder, Cohen and colleagues (1993) demonstrated that only 1 of the 14 patients taking lithium prophylaxis relapsed within the first 3 months postpartum, as compared with 8 of the 13 who did not receive prophylaxis. Although the efficacy of lithium in this setting has been described, the efficacy of other mood stabilizers (i.e., valproic acid, carbamazepine) and antipsychotic agents in this...

Preconception Issues And Care

Women with a past history of severe depression or puerperal psychosis should be counselled regarding relapse rates (about 50 ) in future pregnancies. Medication should not be abruptly discontinued. Many antidepressants are safe in pregnancy mood stabilisers may cause fetal defects, but again the risk-benefit ratio should be assessed to decide whether discontinuation is indicated.

172 Postnatal Psychiatric Disorders 211

Psychosocial risk factors play a role in causing mild to moderate depression. However, in severe depression and in puerperal psychosis, biological factors are more important. Puerperal psychosis presents acutely, usually 3-7 days postpartum Severe depression and puerperal psychosis need referral to specialist perinatal psychiatric services

21 Parent Factors Impacting Child Outcomes

Schizophrenia 1.5 Genetic, twin, and family studies indicate that children born to parents with major mental illnesses are at higher risk to develop the same and other psychiatric illnesses than children whose parents do not have the illness. Table 1 shows the risks for children of parents with schizophrenia, major depression, and bipolar disorder. The heritability of schizophrenia is high, between 60 and 81 , and multiple genetic loci are thought to be involved (16-18). The heritability for major depression is estimated to be in the 10- 45 range (19,20). The genetic heritability of bipolar disorders (with mania and depression) is higher than for unipolar depression (21). When a psychiatric disorder is present in both parents or in a parent and a grandparent, children may be more likely to develop the disorder than if only one parent expresses the disorder (22,23). Parental mental illness symptoms can influence child outcomes, with more severe or persistent symptoms generally being...

3 Environmental Factors Impacting Child Outcomes

For example, low SES or single parenthood has been associated with low birthweight (LBW) and slower development in infants of parents with psychosis or depression (24,110). Moreover, the effects of maternal mental illness on child outcome have been found to be different depending on the mother's SES and background. Research on high-risk depressed women (e.g., low SES, education, and support) has generally found that maternal mental illness was associated with more parenting problems and poor child outcomes (e.g., refs. 57 and 111), whereas studies of low-risk depressed women (e.g., middle income, educated, married women) did not confirm these associations (e.g., refs. 53 and 54). In a meta-analysis of 46 observational studies of maternal depression and parenting, the effect sizes for parenting behavior among socio-economically disadvantaged women were moderate, whereas the effect sizes were not different from zero among women who were not disad-vantaged (64), indicating that...

SPECT single photon emission computerized tomography scanning

Another excellent AED with multiple mechanisms of action. Good for focal and generalized seizures found helpful with Lenox-Gastaut syndrome, infantile spasm, and other seizure types. Generally very well tolerated may cause a decrease in the appetite and psychosis. At times, it may also be associated with a temporary sedative effect. For some children it may be the only medication that can completely control frequent intractable seizures. much less adverse reaction compared to ACTH (the standard treatment for infantile spasms). Sabril is one of the GABA designer medications, and the only one that effectively does what it was designed to do. Sabril blocks the degradation of GABA by blocking the effect of the enzyme GABA transaminase, thus increasing GABA concentration in the presynaptic area. Other side effects of Sabril include psychosis (rare), and some mild fatigue or gastrointestinal upset, which are related.

Addictive Disorders

SIGN 2002 Postnatal Depression and Puerperal Psychosis -A national clinical guideline. Edinburgh Scottish Intercollegiate Guidelines Network 9. Blackmore E, Jones I, Doshi M, Haque S, Holder R, Brockington I and Craddock N 2006 Obstetric variables associated with bipolar affective puerperal psychosis. British Journal of Psychiatry, 188 32-36

3 Treatment Of Postpartum Mood Disorders

It is important to take into consideration the psychosocial as well as the biological contributions to mental disorders in any patient presenting with depression or psychosis. This is particularly true when women present in the puerperium. At no other time in a woman's life is she required to navigate a developmental transition that is potentially wrought with challenging psychodynamic issues, and changes in interpersonal relationships, all in the context of sleep deprivation and profound hormonal and physiological adjustments. Thus, treatment must address potential situational and interpersonal factors as well as target the specific symptoms. Benzodiazepines (118-128), mood stabilizers (129-158), and antipsychotic medications (159-168) are all used frequently in the treatment of postpartum psychiatric disorders, despite the lack of thorough, well-controlled studies in this population. In general, short-term, low-dose use of benzodiazepines is considered fairly safe during lactation....

Psychotherapeutic and Pharmacotherapeutic Interventions

Postpartum Psychosis Postpartum psychosis is considered a psychiatric emergency that typically requires inpatient treatment. The management of post-partum psychosis remains largely empirical, with few definitive data and no controlled studies to guide treatment. Given the well-established relationship between puerperal psychosis and bipolar disorder (Reich and Winokur 1970 Targum et al. 1979), postpartum psychosis should be treated as an affective psychosis. Acute treatment with a mood stabilizer, in addition to antipsy-chotic medications, is indicated. Electroconvulsive therapy (often bilateral) is well tolerated and rapidly effective. Failure to treat puerperal psychosis aggressively places both the mother and the infant at increased risk for harm. Rates of infanticide associated with untreated puerperal psychosis have been estimated to be as high as 4 (d'Orban 1979). Although some authors recommend the discontinuation of psychotropic medications soon after the psychosis clears,...

2118 Atypical antipsychotic drugs

Atypical antipsychotics may be used during pregnancy when treatment of acute psychosis or chronic psychotic illness is necessary. If possible, olanzapine or quetiapine are preferred because these have the most documented experience in pregnancy. Treatment with other atypicals is not an indication for termination of pregnancy. Furthermore, a pregnant patient who is stable with one of the less well-known antipsychotics should not be changed to another drug, because this may worsen her health. However, a detailed fetal ultrasonography may be offered after their use in the first trimester. Regular psychiatric and obstetric care is recommended to diagnose in time a relapse or pregnancy complications (intrauterine growth retardation, premature contractions). Observation of the neonate for withdrawal symptoms or adaptation problems for at least 2 days is recommended when atypical antipsychotics have been used up to delivery. To prevent neonatal adaptation disorders, dose...

Risk and Course of Bipolar Disorder During the Postpartum Period

BD is also closely associated with postpartum psychosis (Brockington et al. 1982 Platz and Kendell 1988 Stewart et al. 1991). Several studies have demonstrated that women presenting with post-partum psychosis often go on to develop a BD (see Rhode and Marneros 2000). Postpartum psychosis is a rare condition in the general population, with incidence estimated at 1-2 per 1,000 (0.1 -0.2 ). However, for women with BD, the risk may be increased to 100-200 per 1,000 (10 -20 ) (Brockington et al. 1982 Platz and Kendell 1988 Stewart et al. 1991). Postpartum psychosis is characterized by rapid onset of symptoms, often within the first 48-72 hours after delivery. Patients with postpartum psychosis may present with a delirium-like condition that is often indistinguishable from manic psychosis. Postpartum psychosis is a psychiatric emergency associated with high rates of infanticide and suicide (D'Orban 1979) it requires expeditious, aggressive treatment with a mood stabilizer and neuroleptic...

73 School Aged Children

Elana was diagnosed with schizophrenia when she was 26 and thereafter relied on disability payments. She had a son, Rico, with a man who was later diagnosed with bipolar disorder and who drank alcohol and used drugs. The parents lived in neighboring rural towns but raised their son together with the help of the father's extended family, who doted on Rico. Elana was a gentle and concerned parent. Throughout his schooling, Rico required extra help. He was diagnosed with a learning disability and later with mild depression. At age 12, he became embarrassed by his mother's frequent, lengthy letters and concerned phone calls to his school as well as by her persistent belief that she was inhabited by ghosts. At age 15, he began smoking marijuana regularly with his friends and failed most ofhis classes. He did not complete high school. He did not develop schizophrenia or bipolar disorder, but he smoked marijuana daily throughout his 20s. He maintained employment at a local manufacturing...

Vitamin F essential fatty acids

A lack of DHA supplied to the fetus and neonate via the mother can lead to a variety of long-term problems and conditions, such as hyperactivity, dyslexia, depression, alcoholism, drug addiction and schizophrenia. The decline in fish consumption has led to a reduction in the amount of DHA in the maternal diet. (For food sources see Second trimester above.)

Postpartum Mood Disorders

The postpartum period has clearly been defined as a time of increased vulnerability to psychiatric illness in women. In one of the most frequently cited studies of postpartum psychiatric illness, Kendell and colleagues (1987) demonstrated that women experience a dramatic increase in their risk of severe psychiatric illness in the first 3 months after the birth of a child. During the postpar-tum period, up to 85 of women experience some type of mood disturbance (Henshaw 2003). Most of these women experience the transient and relatively mild mood symptoms called the blues. About 10 -15 of women experience a more disabling and persistent form of mood disturbance, either postpartum depression (PPD) or postpartum psychosis (G.L. Cooper 1989 P.J. Cooper et al. 1988 Cox et al. 1993). Although postpartum mood disorders are relatively common, depressive symptoms emerging during the postpartum period are frequently overlooked by patients and their caregivers (Coates et al. 2004 Evins et al....

Victoria Hendrick

Many pregnant women and new mothers require treatment for a psychiatric illness. The most common psychiatric illnesses among women of reproductive age involve depressive and anxiety disorders. More severe conditions, such as bipolar disorder or schizophrenia, also typically manifest their first symptoms during the reproductive years. In many cases, psychiatric treatment will include the use of a medication. This chapter reviews important considerations in providing psychiatric treatment during pregnancy and the postpartum period to maximize the safety and well-being of the mother and the child. Nonaffective psychosis a Nonaffective psychosis includes schizophrenia, schizophreniform disorder, delusional disorder, and atypical psychosis. NCS, National Comorbidity Survey (7). a Nonaffective psychosis includes schizophrenia, schizophreniform disorder, delusional disorder, and atypical psychosis. NCS, National Comorbidity Survey (7). In addition to attending to the risks of medication use...

Bipolar Disorder

Tenance, compared with recurrence rates in 59 age-matched nonpregnant women (Viguera et al. 2000). Although recurrence rates among the pregnant women were similar to those rates in the nonpregnant control subjects, recurrences of illness were 2.9 times more frequent in the postpartum compared with nonpregnant women. These findings suggest that risk of recurrent illness increases sharply during the postpartum period. In this study, 70 of women with bipolar disorder experienced illness during the postpartum period. Although those women who experienced recurrent symptoms during pregnancy were at highest risk for illness after delivery, recurrent illness occurred at high rates in women who were euthymic during pregnancy (Nonacs et al. 1999). None of the patients in this study developed psychotic symptoms however, other studies have demonstrated that women with bipolar disorder are at high risk for developing postpartum psychosis (Dean et al. 1989 Reich and Winokur 1970).

Psychotic Disorders

Acute psychosis during pregnancy is both an obstetric and a psychiatric emergency. Similar to other psychiatric symptoms of new onset, first onset of psychosis during pregnancy cannot be presumed to be reactive it requires a systematic diagnostic evaluation. Psychosis during pregnancy may inhibit a woman's ability to obtain appropriate and necessary prenatal care and may impede her ability to cooperate with caregivers during delivery (Miller 1990 Spielvogel and Wile 1992 Wrede et al. 1980). Furthermore, case reports of psychosis during pregnancy suggest that it increases the risk of postpartum psychosis (Spielvogel and Wile 1992 Wrede et al. 1980).

4 Conclusion

Childbirth represents an enormous developmental transition for women, which, in the best of circumstances, is accompanied by mild mood changes and psychosocial interpersonal adjustment. The patient's psychological status during pregnancy and the early puerperium should be discussed openly during prenatal visits so that full disclosure of past psychiatric history and other potential risk factors for PPD or psychosis can be obtained. Screening for PPD can be enhanced by the incorporation offormal mood assessments during obstetrical appointments. These rating scales can be completed by the patient while waiting for the physician or midwife and provide a clear indication of the practitioner's interest in the patient's psychological well-being. An active and up-to- The pathogenesis of PPD is not well elucidated, and treatment studies focusing specifically on depression during the puerperium are scant at best. Thus, at the present time treatment of PPD and other mood disorders during the...

84 Antidepressants

Antidepressants may precipitate mania or rapid cycling in women who suffer from PPD or postpartum psychosis with prominent depressive features (112,117,167). If an antidepressant is used in managing postpartum psychosis, it should, of course, be used only in conjunction with a mood stabilizer (168,169).

Mary V Seeman

The aim of this chapter is to outline the reproductive care needs of women suffering from schizophrenia. After a brief introduction about the illness and the medications used to treat it, the chapter reviews antenatal needs, course of illness during pregnancy, risks to mother and fetus when illness goes untreated, the outcomes of pregnancy for women with schizophrenia, the postpartum course, later outcomes for offspring, the benefits and risks of antipsychotic medication during pregnancy and breast-feeding, and the general services that these women require. Optimal intervention during pregnancy and the postpartum period helps prevent psychiatric disability in the next generation. Key Words Schizophrenia women pregnancy breast-feeding postpartum.

5 Pregnancy Outcomes

The available literature points to an increased risk of obstetrical complications in this population (20). A recent study examined nonoptimal pregnancy outcome in schizophrenia. The study sample was comprised of 2096 births by 1438 mothers diagnosed with schizophrenia and 1,555,975 births in the general population. Significantly increased risks for stillbirth, infant death, preterm delivery, low birthweight (LBW), and small-for-gestational-age were found among the offspring of women with schizophrenia. Women with an episode of schizophrenia during pregnancy had a fourfold increased risk of LBW and stillbirth. Controlling for a high incidence of smoking during pregnancy among these women (51 vs 24 in the general population) and other maternal factors (single motherhood, maternal age, parity, maternal education, mother's country ofbirth, and pregnancy-induced hypertensive diseases) in a multiple regression model reduced the risk estimates markedly. However, the risks for adverse...

7 Later Outcomes

Children of mothers with schizophrenia are a high-risk group for developing later psychopathology (26). In the Swedish High-Risk Project, the offspring of mothers with schizophrenia (n 28) showed a significantly increased frequency ofDiagnostic andStatisticalManualof Mental Disorders, 3rd ed., revised, axis I and axis II disorders compared with offspring of controls (n 91). In addition, these children were found to have poor global functioning, high symptom checklist-90 scores, and a history of mental health care and psychopharmacological medication use (27). Some of the early psychopathology of these children may reflect their genetic predisposition to developing schizophrenia (28). This is important to underscore because child protective services can attribute the child's slow development and psychopathology to bad mothering and can, on this basis, remove the child from the mother. This is unfair to a mother who is doing her best with a difficult child under difficult circumstances....

12 Conclusion

Women with schizophrenia are a group for whom family education, pregnancy, and parenting services have not traditionally been regarded as necessary. As these women become integrated into community living, it is important to anticipate pregnancy and to provide the necessary education, support, and services to ensure successful parenting. In this way, the children of these disadvantaged mothers will not themselves become disadvantaged. Prevention of psychiatric disability is difficult because much of the toll is a result of inherited factors and chance occurrence. The most profitable area for prevention is early on, during the pregnancy of mentally ill mothers. The children born to these mothers are at high genetic risk and at high parenting risk. Knowledgeable intervention at the time of pregnancy is the most effective strategy available in the prevention of second-generation psychiatric disorder.

What causes it

There is not really space in this book to cover this issue in depth. Like most psychological problems, a combination of genetic, biological, environmental and social factors has been studied. It is worth emphasising again that these types of illness are extremely rare. Also there are different factors involved depending on whether this is the first time that you have been ill or whether you have a history of (psychotic) mental illness. Where a woman has a history of manic-depression or schizophrenia she is more at risk for developing these problems. However, it is more likely that under these circumstances your doctors will monitor your pregnancy more closely and it may be that medical treatment is commenced shortly after the baby is born in order to prevent puerperal psychosis taking place.

Course and Prognosis

The duration of postpartum illness appears to be variable. Puerperal episodes are often relatively short-lived and may last no more than 3 months (Cooper and Murray 1995). Many women, however, have a more prolonged illness, and several studies suggest that depressive episodes tend to be longer and more severe in those with histories of major depression (Cooper and Murray 1995 Goodman 2004). Some reports suggest that duration may be related to the severity of illness (Horowitz and Goodman 2004). In general, women with postpartum mood disorders have a good prognosis. In about half of the cases, puerperal depression or psychosis represents the first onset of a recurrent psychiatric illness (O'Hara 1995). Although there appears to be a subpopulation of women who have only puerperal episodes of psychiatric illness, the majority of women with a postpartum affective disorder will go on to have episodes of psychiatric illness unrelated to pregnancy or childbirth (Robling et al. 2000). Rates...

How is it treated

Puerperal psychosis needs immediate psychiatric intervention. Women will usually need to go into hospital to be assessed and monitored. They will usually need drug treatment and intensive support around caring for the baby. The relatives too will need support and information. A GP or a visit from the community midwife cannot provide this level of support. Because the presentation of post-partum psychosis is so dramatic, usually the services respond very quickly. Often the problems develop before the mother has left hospital, within hours of the birth.

Types of depression

There are basically five categories of depression after childbirth, any of which can merge together the 'baby blues', postnatal exhaustion, postdelivery stress, severe postnatal depression and puerperal psychosis. Puerperal psychosis This is an acute psychiatric illness that requires prompt treatment, affecting about one woman in every 1000 (Kendell 1985). Occasionally severe episodes of the blues can lead to postnatal depression and untreated depression can develop into a major depressive psychosis.