Why seek treatment for Psychotic Disorders and Postpartum Psychosis?
Women experiencing psychosis because of a Psychotic Disorder, including Schizophrenia and Schizoaffective Disorder or Postpartum Psychosis are at risk of harm to themselves or others. This may include committing suicide and, in very rare cases, harming their baby. Experiencing psychosis can be a frightening experience as can witnessing it in a loved one.
The onset of psychosis, whatever its cause, is a psychiatric emergency and the woman needs to be hospitalized immediately. Because she is probably out of touch with reality she may not have the insight to recognize how ill she is. The decision for hospitalization may need to be made by her physician or her family although efforts to involve the woman in decision making are desirable.
Safety of the mother and the infant are the most important priorities. If available, a mother-baby unit or a designated bed on a maternity ward where all mother and baby contact could be supervised, is recommended. Ideally, it is preferable not to separate the baby from the mother so that bonding can be promoted. However, this may not always be possible if the mother is too ill or local facilities are unavailable.
What are the treatment options for women with Psychotic Disorders or Postpartum Psychosis?
There are a range of possible treatments for psychosis and psychotic disorders. Antipsychotic medications, which include both older, typical and newer, atypical neuroleptics are usually necessary, in addition to other non-pharmacological treatments.
Pharmacological Treatments
Following diagnosis, the treating physician will prescribe the safest drug therapies during pregnancy or for the breastfeeding woman. Antipsychotic medications are usually prescribed and sometimes, mood stabilizer medications are prescribed in addition. Benzodiazepines may also be utilized on a short term basis to help control symptoms until the antipsychotic medications take effect.
How do Antipsychotic Medications work?
Antipsychotic medications work by affecting neurotransmitters in the brain that allow communication between cells. Although they show some effect immediately, it may take between one and two weeks to know the exact effect on the woman’s mood and symptoms.
The goal of treatment is to minimize risk of exposure of the fetus or of the breastfed baby to antipsychotic medication while limiting risks of untreated psychiatric disorders. Ideally the woman should be on the lowest effective dose of antipsychotic medication to treat her symptoms.
All antipsychotic medications have some adverse effects but it is important not to suddenly stop taking medications. Talk through possible side effects with the treating physician and always discuss any changes with them.
Antipsychotic medications during pregnancy need to be carefully managed. Referral to a psychiatrist or reproductive psychiatrist is recommended for assistance with developing an individual care plan for the woman. This will include discussing the management of her medications during the perinatal period (pregnancy and the year following the birth).
Any woman taking antipsychotics who unexpectedly becomes pregnant should not stop taking medication but should consult with her treating physician and/or psychiatrist as soon as possible.
Antipsychotic medications and breastfeeding : antipsychotic medications do pass into the mother’s breast milk. It is important to monitor the baby for any side effects (e.g., drowsiness or floppiness). Consult with your physician to decide what is best for you and your baby.
Mood stabilizing medications during pregnancy : Lithium, and lamotrigene are commonly used mood stabilizing medications in pregnancy. Where possible, it is recommended to avoid the use of valproic acid during pregnancy as they are associated with an increased risk of malformations in the baby, especially spina bifida. There are other antipsychotic medications which also have mood stabilizing effects and can be used in pregnancy as an alternative to valproic acid.
As with antipsychotics, the lowest effective dose to control symptoms will be sought and careful management is required as there are some risks associated with these medications. Consultation with the woman’s treating physician and/or psychiatrist is advised to form an individual care plan. As with antipsychotics, any woman diagnosed with a psychotic illness and taking mood stabilizers who is considering becoming pregnant, would be best advised to consult with a psychiatrist to plan management of her medications during the perinatal period.
Mood stabilizing medications and breastfeeding : Breastfeeding and mood stabilizers are compatible but caution is advised and the lowest effective dose will be sought. Extra caution is advised with the use of lithium and the baby’s lithium levels will need to be closely monitored. As with antipsychotic medications, consult with your treating physician to work out a care plan that is best for you and your baby.
In some circumstances, a treating psychiatrist may suggest ECT (Electro Convulsive Therapy), such as where the illness is severe and the risk of suicide is high and a rapid response is needed to the symptoms or where a woman cannot tolerate or take medications.
Non – Pharmacological Treatments
Usually offered in addition to pharmacological treatment once medications are established and symptoms are subsiding.
- Psycho education : for the woman, her partner, friends and family to understand more about the illness, the importance of building social networks and supports and general strategies for coping in the short and longer term..
- Family and Relationship Counselling: It is important to assist women, their partners and family to develop focused strategies to cope with this stressful time.
- Psychotherapy: Either interpersonal therapy or group therapy offering support to develop insight into the illness, different ways of managing thought processes and feelings is helpful. Cognitive Behaviour Therapy is also a helpful treatment.
Summary
As with all other mental health challenges and disorders, women with Postpartum Psychosis or psychotic disorders such as Schizophrenia require support from healthcare providers, partners, family and friends. Care can be quite complex, requiring an integrated, multi disciplinary approach and the careful development of a treatment plan that includes discussion with the woman, her partner and family. Important components of the woman’s Individual Care Plan should include:
- education about the illness, especially how it may be affected by pregnancy and the postpartum
- developing support systems,
- developing a crisis plan
- helping the woman to maximize her own health
- helping the woman to minimize her risk of relapse
Medications prescribed for psychosis do have potential side effects for the baby and the baby should be monitored closely. It is important however that the woman does not discontinue her medication without consultation with her treating physician or psychiatrist as there will then be a risk of relapse in her mental illness.
With good planning, interdisciplinary working and good partner, family and community support for the woman, the risks and impacts of psychotic disorders and postpartum psychosis can be effectively managed.