Clinical interventions for women with schizophrenia: pregnancy

Abstract

In 1997, Miller (1) inaugurated the field of specialized reproductive care for women with schizophrenia by reviewing what was then known about how the illness affects sexuality, pregnancy, the postpartum period, parenting, and family planning. She reported that women suffering Seeman MV. Clinical interventions for women with schizophrenia: pregnancy.Objective: A comprehensive treatment program for schizophrenia needs to include services to women of childbearing age that address contraception, pregnancy, and postpartum issues, as well as safe and effective parenting. To update knowledge in these areas, a summary of the recent qualitative and quantitative literature was undertaken. Method: The search terms Ôsexuality,Õ Ôcontraception,Õ Ôpregnancy,Õ Ôpostpartum,Õ Ôcustody,Õ and ÔparentingÕ were entered into PubMed, PsycINFO, and SOCINDEX along with the terms ÔschizophreniaÕ and Ôantipsychotic.Õ Publications in English for all years subsequent to 2000 were retrieved and their reference lists further searched in an attempt to arrive at a distillation of useful clinical recommendations. Results: The main recommendations to care providers are as follows: take a sexual history and initiate discussion about intimate relationships and contraception with all women diagnosed with schizophrenia. During pregnancy, adjust antipsychotic dose to clinical status, link the patient with prenatal care services, and help her prepare for childbirth. There are pros and cons to breastfeeding while on medication, and these need thorough discussion. During the postpartum period, mental health home visits should be provided. Parenting support is critical. Conclusion: The comprehensive treatment of schizophrenia in women means remembering that all women of childbearing age are potential new mothers. M. V. SeemanDepartment of Psychiatry, University of Toronto, Toronto, ON, Canada Key words: schizophrenia; psychosis; pregnancy; postpartum; ethics Mary V. Seeman, Professor Emerita, Department of Psychiatry, University of Toronto, Toronto, ON, Canada M5P 3L6. E-mail: mary.seeman@utoronto.ca Accepted for publication May 25, 2012 Clinical recommendations• Engage all women patients with schizophrenia who are of childbearing age in discussions of intimacy, sex, sexually transmitted disease, conception, and contraception.• Carefully monitor all women with schizophrenia who are pregnant and be prepared to adjust antipsychotic doses frequently, as per clinical status.• Provide ongoing support to women with schizophrenia who are parents, and to their children. Additional comments• All women of childbearing age need to be treated as potential new mothers.• There is room for discussion as to the ÔrightÕ course of treatment of schizophrenia during pregnancy and the postpartum period.• The perspectives of all stakeholders need to be respected and considered.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders

“…The preferred community-based treatment model provides greater socialisation and hence greater opportunities for sexual relationships. Clearly, there are many psychosocial issues facing pregnant women with schizophrenia, which clinicians need to address with their female patients (Seeman, 2013a).…”

Reproductive Health Issues for Adults with a Common Genomic Disorder: 22q11.2 Deletion Syndrome

“…Changes in maternal physiology during pregnancy that may exacerbate select medical problems (e.g., schizophrenia, cardiac disease, thyroid disease) and potential teratogenicity of certain medications should prompt reassessment of the treatment plan Negro and Mestman 2011;Seeman 2013;Thorne 2004). …”

“…• Optimization of health conditions pre-conception • Reassessment of treatment plan, considering the potential for disease exacerbations from pregnancy, teratogenicity of medications, patient non-adherence, and negative maternal and fetal consequences of untreated morbidities (Negro and Mestman 2011;Seeman 2013;Thorne 2004) • Antenatal care, delivery, neonatal evaluation, and postpartum care in a high-risk obstetric center with an experienced multidisciplinary team Hatton et al 2012;Seeman 2013) • Appropriate screening during pregnancy, including early fetal echocardiogram to screen for congenital heart disease (Rasiah et al 2006) Social support • Awareness of potential sources of conflict between patient and partner/family (Finucane 2010;Karas et al 2014) • Tailoring of support based on the individual patient's needs and his/her existing supports (e.g., social work, child care resources, child protection services, financial resources) (Butcher et al 2012;Finucane 2010;Karas et al 2014) Sexual and reproductive health…”

Loss of Libido in a Woman With Schizophrenia

“…J and her husband spent several joint visits discussing the difficulties of pregnancy and parenting in the context of schizophrenia (36)(37)(38)(39)(40)(41). They already knew how difficult it was to maintain child custody in the face of illness (42,43) because the child protection services had been called in when Ms. J suffered her first episode of psychosis after the birth of her son.…”