Acute Psychiatric Conditions in Pregnancy

An Obstetric and Psychiatric Emergency: Managing Acute Agitation Among Pregnant Patients in the Emergency Department

“…Undertreated women with schizophrenia and schizoaffective disorder may experience recurrent psychotic episodes and exhibit hallmark symptoms of psychosis, such as hallucinations, delusional thinking, or disorganized thoughts (Puryear, 2018; Rodriguez-Cabezas & Clark, 2018; Roppolo et al, 2020). Pregnant patients with a history of bipolar disorders may present with manic, hypomanic, depressive, or mixed bipolar episodes from rapid reduction or discontinuation of mood stabilizers at any time during pregnancy (Puryear, 2018). Those with bipolar I and mixed bipolar disorder often experience the most prominent phase of mania, which is characterized by a euphoric or irritable mood and heightened energy state, associated with grandiosity, rapid pressured speech, racing thoughts, impulsiveness, sleep disturbance, and psychomotor agitation (Clark & Wisner, 2018; Garriga et al, 2016; Puryear, 2018).…”

“…It is important to note that new onset of psychosis in pregnancy is rare, and clinicians must differentiate acute psychiatric illnesses from organic causes during the initial evaluation (Anderson, 2021). Abrupt cessation of routine psychotropic medications during pregnancy can frequently result in a relapse of psychiatric conditions (Garriga et al, 2016; Puryear, 2018; Rodriguez-Cabezas & Clark, 2018). Undertreated women with schizophrenia and schizoaffective disorder may experience recurrent psychotic episodes and exhibit hallmark symptoms of psychosis, such as hallucinations, delusional thinking, or disorganized thoughts (Puryear, 2018; Rodriguez-Cabezas & Clark, 2018; Roppolo et al, 2020).…”

“…Abrupt cessation of routine psychotropic medications during pregnancy can frequently result in a relapse of psychiatric conditions (Garriga et al, 2016; Puryear, 2018; Rodriguez-Cabezas & Clark, 2018). Undertreated women with schizophrenia and schizoaffective disorder may experience recurrent psychotic episodes and exhibit hallmark symptoms of psychosis, such as hallucinations, delusional thinking, or disorganized thoughts (Puryear, 2018; Rodriguez-Cabezas & Clark, 2018; Roppolo et al, 2020). Pregnant patients with a history of bipolar disorders may present with manic, hypomanic, depressive, or mixed bipolar episodes from rapid reduction or discontinuation of mood stabilizers at any time during pregnancy (Puryear, 2018).…”

“…Pregnant patients with a history of bipolar disorders may present with manic, hypomanic, depressive, or mixed bipolar episodes from rapid reduction or discontinuation of mood stabilizers at any time during pregnancy (Puryear, 2018). Those with bipolar I and mixed bipolar disorder often experience the most prominent phase of mania, which is characterized by a euphoric or irritable mood and heightened energy state, associated with grandiosity, rapid pressured speech, racing thoughts, impulsiveness, sleep disturbance, and psychomotor agitation (Clark & Wisner, 2018; Garriga et al, 2016; Puryear, 2018). Patients with personality disorders may also have psychomotor agitation as a clinical manifestation, particularly those with borderline personality disorder and antisocial personality disorder (Ferrer et al, 2022).…”