Mental health articles

Pregnancy and the postpartum period is a time of psychiatric vulnerability for women, and both treatment and lack of treatment of mental illness carry some risk to both mother and child. Still, mental illness during this vulnerable time is predictable, identifiable, treatable, and, therefore, preventable. For the clinician treating a patient with a history of mental illness, pregnancy and postpartum period is a unique opportunity to collaborate actively with his or her patient to enhance good outcomes and help women enjoy this major life stage.

When counseling patients with mental illness regarding treatment options,
it is important to elucidate the risks and benefits of treatment options for
each pregnancy phase—preconception, first trimester, second trimester, third trimester, neonatal, and later in life. The risks associated with treatment change with both phases of pregnancy and the postpartum period as well as with the needs and symptom burden of the patient. Critically important is a thorough discussion of the risks both of the treatments and of untreated depression, as it evolves in pregnancy and the postpartum period .A careful and complete assessment of and follow-up with women suffering from mental illness in pregnancy/postpartum periods should include a thorough exploration of potential psychotic symptoms and a careful safety assessment to prevent harm to both mother and child. Inquiry into the presence of bizarre delusions of influence or passivity, tactile or olfactory hallucinations, or cognitive
impairment may indicate an emerging psychosis, for which psychiatric
hospitalization should be strongly considered.
Mental illness itself can put women at risk for poor pregnancy outcomes, but improved research methods can help us understand the factors contributing to increased risk. Once we identify and understand the risk factors that are modifiable in treating women with mental illness, we can begin to help address such factors, with the goal of witnessing improved outcomes for both mother and child.
The goal of the mental health practitioner and patient team is to maintain
mental health in women with histories of mental illness. An understanding of high risk times in pregnancy and postpartum along with identification of signs of relapse are important first steps. Clinicians and patients should be aware of relapse triggers and early warning signs (e.g., changes in sleep, hygiene, cognitive changes, affective changes). Additionally, both the clinician and patient should understand the evolving needs of the pregnant and postpartum period and adjust treatments accordingly (including but not limited to dosing of medications, timing and frequency of visits, inter-visit communication, collaboration with family, other care providers, and outside agencies). The primary medical providers and family should be contacted for collateral information about the patient and to offer psychoeducation and guidance throughout the regnancy and postpartum period. Engagement and rallying of loved ones and
caregivers can help establish a scaffolding upon which supports of the expectant nd new mother can be positioned. Most cases also merit referral to high risk bstetrics for comanagement.
Many clinicians who successfully manage mental illness in pregnancy and he postpartum period expand the frame of treatment during this time of evolving eeds. The clinician has a duty to collaborate with the patient’s other care roviders for information exchange as well as the development of a unified an of ongoing and contingency management. Collaboration with family and edical providers can have a significant impact in maternal and fetal outcomes.imilarly the rallying of family supports in the form of
collaborative sessions, psychoeducation, and contacts with family members (with patient consent) is helpful. Clinicians may also serve as sounding boards or patients to better understand the normal range of reactions to the enormous ife changes they face. The clinician can help navigate information, encourage atients to seek advice and help from others, provide resources and outlets, and uggest strategies to help in the care of both mother and her growing family.

Tags: postpartum, pregnancy, Psychiatric