Citation

Spielvogel AM. Int. Med. J. 1997; 4(2): 87-92.

Copyright

(Copyright © 1997, Japan International Cultural Exchange Foundation)

DOI

unavailable

PMID

unavailable

Abstract

Pregnancy previously thought to be a state of increased psychological well being has recently been recognized as a time of significant stress, sometimes resulting in psychiatric symptoms. Psychotherapy can be particularly helpful during pregnancy, since a working through of early object relationship difficulties naturally emerges with the women's need to accept her fetus and increasingly affiliate with the baby as a separate person. In vulnerable women new onset or worsening of obsessive compulsive symptoms, eating disorders, panic attacks and depression have been described. Women with major mental illness such as schizophrenia, schizoaffective or bipolar disorders are particularly at risk for decompensations during pregnancy. Their illness is often complicated by substance abuse, resulting in inadequate prenatal care, difficulties detecting labor and caring consistently for their newborns. Optimal care can be provided by a multidisciplinary team including obstetricians, social workers, nurses and psychiatrists with expertise in pregnancy and postpartum related illnesses. Assessment, psychotherapy focused on the psychological tasks of pregnancy, use of psychotropic medication during pregnancy and the postpartum within a culturally sensitive context will be described. Women with chronic severe mental illness often require psychotropic medication and hospitalization. The increased incidence of psychiatric hospitalization in the first three months after birth has been well documented across a number of different populations. The most devastating postpartum disorder, postpartum psychosis, which occurs in 1:1000 deliveries, poses a risk of suicide or infanticide. Alerting families and the health care community to the risks in women with bipolar illness, to the warning signals of postpartum disorders and to effective treatment options is a major goal for psychiatrists working with obstetric patients. Key references are selectively reviewed for the topics covered in this paper.

Language: en

Keywords

Medication; Mental health; Postpartum; Pregnancy; Treatment