Special issues for women with psychosis
Pregnancy and postpartum
The desire to reproduce is both a powerful urge and a basic human right for women, regardless of mental health status. Deinstitutionalized treatment for mental illness, better pharmacotherapies, and generally higher expectations for a normal quality of life all have the potential to raise the incidence of pregnancy in women with psychosis (Miller et al., 1992). It has been estimated that more than 50% of women with psychotic illness are mothers (Howard et al., 2001, McGrath et al., 1999). Many of these women will therefore require ongoing antipsychotic treatment during pregnancy and the postpartum period to avoid severe psychosis relapse, and optimize their wellbeing and capacity to care for their newborn.
The right of women with mental illness to become a parent places responsibility upon health care professionals to ensure sound antenatal and ongoing care is available. Antipsychotic medications are being prescribed to a growing number of women with mental illness. However, there is currently insufficient evidence regarding their safety in pregnancy, which complicates decision-making for clinicians and patients. This clinical dilemma is the driving force behind the establishment of The National Register of Antipsychotic Medication in Pregnancy (NRAMP) (Kulkarni et al., 2014), an ongoing Australia-wide observational study that follows mothers who take antipsychotic medications during pregnancy and tracks progress of both woman and infant.
The preliminary results of the NRAMP study highlight the need to be particularly vigilant for metabolic complications during pregnancy (e.g. excess weight gain, gestational diabetes) and worsening of psychotic symptoms, particularly during postpartum (Kulkarni et al., 2014). Women should be screened regularly for diabetes and hypercholesterolemia. Attention to lifestyle factors such as diet, exercise, smoking, and alcohol cessation are important, and the PCP is ideally placed to have a positive impact on these health behaviours.