Psychosis

INFORMATION FOR WOMEN WHO HAVE PSYCHOSIS DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is psychosis?

Psychosis is a phenomenon in which thoughts and emotions are disrupted to such an extent that the person is out of touch with reality. The disconnection from reality presents with symptoms that include delusions and hallucinations. A delusion is a belief or idea that a person maintains, even when it is contradicted by reasoning that is accepted by virtually everybody else, or when it is different from what is accepted by people as a whole. There are different categories of delusions. Paranoid delusions, for instance, are delusions in which the underlying disconnection from reality is that everyone else is part of a conspiracy organized against him, or her. Hallucinations are perceptions within a persons mind of things that are not really there and they can involve any of the senses. Visual hallucinations, for instance, are false perceptions that the person is seeing something that is not there, whereas auditory hallucinations are false perceptions that the person is hearing something, for instance, a voice. Other psychotic features include disorganized speech and disorganized behavior.

How common is psychosis during pregnancy?

Psychosis is the principle feature of several conditions that are known collectively as psychotic disorders. Together, psychotic disorders affect approximately 3.5 percent of people worldwide. Researchers have found the incidence of psychotic disorders varies widely between different countries and is highest in younger men and racial and ethnic minorities. However, psychosis also occurs in young and middle-aged women and can happen particularly in association with pregnancy. While a growing number of women with psychotic conditions, such as schizophrenia, are getting pregnant, research also has revealed that it is fairly common for women to suffer what are called psychotic-like experiences (subclinical episodes that seem psychotic but typically are less extreme than actual psychosis) during pregnancy, or just after giving birth.

How is psychosis diagnosed?

Diagnosis is made clinically, by way of a psychiatric evaluation that includes your history and demonstration of features, such as hallucinations, delusions, disorganized speech, or disorganized behavior. These are assessed in terms of criteria that are listed in Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Based on the presence of psychotic features, the amount of time the features have been present, and the degree to which the condition affects your function, an examiner can determine if you meet the requirements for any of several psychotic conditions, such as schizophrenia, brief psychotic disorder, or substance-induced psychotic disorder. If you have a brief psychotic disorder that begins within four weeks of giving birth, the DSM-V diagnosis would be brief psychotic disorder with postpartum onset. This is what used to be called post-partum psychosis.

Does psychosis cause problems during pregnancy?

Psychosis during pregnancy entails an increased risk that the mother will experience problems, such as a need for cesarean delivery or induction of labor, or bleeding (hemorrhage) before or after delivery. One possible cause of hemorrhage before delivery is a serious condition called placental abruption, in which the placenta detaches from the wall of the uterus, thereby cutting off blood flow to the developing baby, but also causing the mother to lose a lot of blood.

Does psychosis during pregnancy cause problems for the baby?

Psychosis in a pregnant woman puts the developing baby at higher risk of poor growth in the uterus, fetal distress (the baby is not doing well, usually because the placenta is not receiving enough blood flow or oxygen), birth defects, premature rupture of membranes (water breaking too early) and preterm birth, as well as stillbirth due to reduced blood flow from the uterus, placental abruption, or other causes.

What to consider about taking medications when you are pregnant:

  • The risks to yourself and your baby if you do not treat the psychosis
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat psychosis during pregnancy?

Many different medications are used to treat psychosis. These drugs are characterized into different groups based on how they are thought to work, and based on how old or how new they are. Older drugs, known as first-generation antipsychotic agents, include phenothiazines and butyrophenones. While these groups have been used only occasionally to treat psychosis in pregnancy, they have been given to pregnant women more often to treat nausea, including a severe condition of nausea and vomiting called hyperemesis gravidarum. One powerful, commonly used butyrophenone called haloperidol has been subject to controversy as to whether it increases the risk of birth defects: there was a report that when given during the first trimester the drug caused abnormalities in the limbs of babies, but this was contradicted by studies involving larger numbers of pregnancies, leading researchers to conclude that haloperidol is probably relatively safe in pregnancy. There is also some concern that a commonly used, lower-potency phenothiazine called chlorpromazine may slightly increase the risk of birth defects when given during the first trimester. Some evidence shows that exposure to chlorpromazine, haloperidol, or other first-generation antipsychotic drugs in the womb may cause temporary problems for the baby involving movement, feeding, the intestines, or jaundice (yellowing of the skin). Physicians also have some concerns about second-generation antipsychotic agents, which include olanzapine, risperidone, clozapine, amisulpride, aripiprazole, and ziprasidone, but more studies are needed to understand the risks.

Who should NOT stop taking medication for psychosis during pregnancy?

If your doctors decide that you require an antipsychotic drug to counter psychosis during or after pregnancy, you are better off continuing with the treatment, since there is a trade-off between risks and benefits. While there has been some concern about effects on the baby, the risks are not fully understood and are thought to be low, whereas the problems connected with psychosis are very severe.

What should I know about choosing a medication for psychosis during pregnancy?

You may find Pregistrys expert reports about the individual medications to treat psychosis here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my psychosis when I am breastfeeding?

Safety limits for antipsychotic medications in nursing mothers have not been established, but tiny amounts entering breastmilk are not thought to be dangerous to full-term infants. More caution is recommended for mothers with preterm infants who take these medications since there are knowledge gaps concerning how easily the drugs enter breastmilk. To be absolutely safe, if you are on antipsychotic medication, you should consider not breastfeed
ing and choosing an infant formula under the direction of your pediatrician.

What alternative therapies besides medications can I use to treat psychosis during pregnancy?

Antipsychotic medications are the gold standard for treating psychosis, but brief psychotic disorder with postpartum onset can be treated with a procedure called electroconvulsive therapy (ECT). This is often the choice after medication proves to be inadequate, so ECT is not really an alternative to medication.

What can I do for myself and my baby when I have psychosis during pregnancy?

You should cooperate with your physicians and family and take your medication as directed, so that you can focus on delivering and caring for your baby.

Resources for psychosis in pregnancy:

For more information about psychosis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


Medications for Psychosis


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