Psychiatric Disorders in Pregnancy and the Postpartum (eBook)

Series Editor’s Introduction 6
Preface 7
Contents 8
Contributors 9
General Considerations in Treating Psychiatric Disorders During Pregnancy and Following Delivery 11
1. INTRODUCTION 11
2. UNINTENDED PREGNANCY 15
3. EFFECT OF PREGNANCY ON DRUG METABOLISM 15
4. PSYCHIATRIC MEDICATION USE NEAR TERM 17
5. POSTPARTUM 18
6. USE OF PSYCHIATRIC MEDICATIONS DURING BREAST- FEEDING 19
7. CONCLUSION 20
REFERENCES 21
Prevalence, Clinical Course, and Management of Depression During Pregnancy 23
1. INTRODUCTION 23
2. PREVALENCE 24
2.1. Current Prevalence Data 24
2.2. Tools Used to Detect the Presence of Depressive Symptoms in Pregnancy 24
3. CLINICAL COURSE 26
3.1. Risk Factors 27
4. RISKS OF UNTREATED DEPRESSION DURING PREGNANCY 28
4.1. Functional Impairment 28
4.2. Substandard Maternal Nutrition and Increased Maternal Weight Loss 28
4.3. Substance Abuse 29
4.4. Pregnancy-Induced Hypertension 29
4.5. Inadequate Prenatal Care 29
4.6. Postpartum Depression 30
4.7. Poor Neonatal Behavioral Development 30
5. TREATMENT OF DEPRESSION DURING PREGNANCY 30
5.1. Nonpharmacological Treatment Options 31
5.2. Pharmacological Treatment Options 31
5.3. Reported Adverse Outcomes 41
6. CONCLUSION 43
REFERENCES 43
Postpartum Depression 51
1. DETECTION: THE FIRST STEP TO SYMPTOM RESOLUTION 52
1.1. The “Mental Health-Friendly” Environment 52
1.2. Routine Screening for Mental Illness in Pregnant and Postpartum Women 52
1.3. The Differential Diagnosis 53
1.4. Who Is at Risk for Postpartum Mood Disturbances? 57
2. BIOLOGICAL UNDERPINNINGS OF POSTPARTUM MOOD DISORDERS 57
3. TREATMENT OF POSTPARTUM MOOD DISORDERS 64
3.1. Incorporating the Biopsychosocial Model of Treatment 64
3.2. Management of the Breast-Feeding Patient 64
3.3. Treatment Studies: The Few and Far Between 74
3.4. Prevention Strategies 76
3.5. Treating Postpartum Psychosis 77
3.6. Specific Recommendations for Treatment 77
4. CONCLUSION 78
ACKNOWLEDGMENTS 79
REFERENCES 79
Treatment of Anxiety Disorders in Pregnancy and the Postpartum 92
1. INTRODUCTION 92
2. PREVALENCE OF PERINATAL ANXIETY DISORDERS 93
3. IDENTIFICATION AND ASSESSMENT 93
4. PRESENTATION OF ANXIETY DISORDERS IN PREGNANCY AND THE POSTPARTUM 94
4.1. Panic Disorder 94
4.2. OCD 95
4.3. PTSD 97
4.4. GAD 97
4.5. Social Phobia 98
4.6. Anxiety Problems Associated With Miscarriage 98
5. TREATMENT 98
5.1. Psychological Treatment 98
5.2. Pharmacotherapy 107
6. CONCLUSION 110
7. CASE REPORT 111
REFERENCES 114
Bipolar Disorder 118
1. INTRODUCTION 118
2. NATURAL COURSE OF BIPOLAR DISORDER IN PREGNANCY 119
3. IMPACT OF PSYCHOTROPIC MEDICATIONS ON OFFSPRING 120
3.1. Lithium 120
3.2. Anticonvulsants 121
3.3. Antipsychotic Agents 122
3.4. Benzodiazepines and Other Sedative Hypnotic Agents 124
3.5. Antidepressants 126
4. ELECTROCONVULSIVE THERAPY 126
4.1. Teratogenicity 126
4.2. Neonatal Toxicity 126
4.3. Neurobehavioral Teratogenicity 126
5. TREATMENT GUIDELINES 126
6. BIPOLAR DISORDER AND THE POSTPARTUM PERIOD 128
7. RELATIONSHIP BETWEEN POSTPARTUM PSYCHOSIS AND BIPOLAR AFFECTIVE DISORDER 129
8. PSYCHOTROPIC MEDICATIONS IN THE MANAGEMENT OF POSTPARTUM BIPOLAR DISORDER 130
8.1. Lithium 131
8.2. Anticonvulsant Mood Stabilizers 132
8.3. Antipsychotics 134
8.4. Antidepressants 135
8.5. Benzodiazepines 136
9. ECT 136
10. PSYCHOTHERAPY 136
11. TREATMENT GUIDELINES 137
REFERENCES 138
Schizophrenia During Pregnancy and the Postpartum Period 148
1. INTRODUCTION 148
2. ANTENATAL NEEDS OF WOMEN WITH SCHIZOPHRENIA 150
3. COURSE OF ILLNESS IN PREGNANCY 152
4. RISKS OF UNTREATED ILLNESS TO MOTHER AND FETUS 152
5. PREGNANCY OUTCOMES 152
6. COURSE OF ILLNESS POSTPARTUM 153
7. LATER OUTCOMES 154
8. ANTIPSYCHOTIC MEDICATIONS IN PREGNANCY 154
9. ANTIPSYCHOTIC EFFECTS ON PREGNANCY OUTCOMES 155
10. BREAST-FEEDING 156
11. SERVICES REQUIRED FOR WOMEN WITH SCHIZOPHRENIA DURING CHILDBEARING YEARS 157
12. CONCLUSION 158
REFERENCES 158
Pregnancy and Substance Abuse 162
1. INTRODUCTION 162
2. ASSESSMENT AND SCREENING FOR SUBSTANCE ABUSE DURING PREGNANCY 163
3. EPIDEMIOLOGY OF SUBSTANCE ABUSE AND PREGNANCY 165
4. MATERNAL ALCOHOL USE 166
4.1 Epidemiology of Fetal Alcohol Exposure 166
4.2. FAS/FAE 167
4.3. Effects of Prenatal Exposure to Alcohol Throughout Life 168
4.4. Treatment for Alcohol Withdrawal Symptoms 169
4.5. Alcohol and Breast-Feeding 169
5. MATERNAL MARIJUANA USE 169
5.1. Epidemiology of Marijuana Use 170
5.2. Fetal Effects of Marijuana 170
5.3. Marijuana and Breast-Feeding 171
6. MATERNAL COCAINE USE 171
6.1. Epidemiology of Cocaine Use 172
6.2. Fetal Effects of Cocaine 172
6.3. Cocaine and Breast-Feeding 174
7. MATERNAL METHAMPHETAMINE USE 174
7.1. Epidemiology of Methamphetamine 174
7.2. Fetal Effects of Methamphetamine 175
7.3. Methamphetamine and Breast-Feeding 175
8. MATERNAL OPIOID USE 176
8.1. Epidemiology of Opioid Use 176
8.2. Fetal Effects of Opioid Use 176
8.3. Methadone Treatment 177
8.4. Methadone and Breast-Feeding 178
8.5. Buprenorphine Treatment 178
8.6. Behavioral Effects of Heroin Use on the Child 179
9. LEGAL ISSUES SURROUNDING PREGNANT SUBSTANCE- ABUSING WOMEN 179
10. CONCLUSION 180
REFERENCES 182
Eating Disorders in Pregnancy and the Postpartum 188
1. INTRODUCTION 188
2. EATING DISORDERS: DEFINITIONS 189
3. IMPACT OF PREGNANCY ON EATING- DISORDER SYMPTOMS 190
4. IMPACT OF EATING DISORDERS ON PREGNANCY COURSE AND OUTCOME 190
5. DETECTION AND ASSESSMENT OF EATING DISORDERS 193
6. ASSESSING THE SUSPECTED PRESENCE OF AN EATING DISORDER 194
7. TREATMENT GUIDELINES 195
8. COURSE OF PREGNANCY FOR WOMEN WITH EATING DISORDERS 197
8.1. First Trimester 197
8.2. Second Trimester 198
8.3. Third Trimester 199
9. HELPFUL STRATEGIES 200
10. POSTPARTUM ISSUES 201
10.1. Weight Loss in the Postpartum Period 202
10.2. Breast-Feeding and Feeding Issues 202
11. CONCLUSION 203
REFERENCES 203
Children of Parents With Mental Illness 206
1. INTRODUCTION 206
2. DETERMINANTS OF CHILD OUTCOMES 207
2.1. Parent Factors Impacting Child Outcomes 208
3. ENVIRONMENTAL FACTORS IMPACTING CHILD OUTCOMES 212
4. CHILD FACTORS ASSOCIATED WITH POOR CHILD OUTCOMES 214
5. WHAT CAN HAPPEN TO CHILDREN OF PARENTS WITH MENTAL ILLNESS? 215
5.1. Effects on Attachment Relationships 215
5.2. Effects on Motor and Cognitive Development 215
5.3. Effects on Behavior and Mental Health 216
6. RISK IS CUMULATIVE 217
7. EXAMPLES OF CHILDREN OF MOTHERS WITH MENTAL ILLNESS 217
7.1. Infants and Toddlers 217
7.2. Preschool Children 218
7.3. School-Aged Children 219
8. INTERVENTIONS TO HELP MOTHERS WITH MENTAL ILLNESS AND THEIR CHILDREN 220
8.1. Perinatal and Postpartum Treatment of Maternal Mental Illness 221
8.2. Parent Training and Family Support With High- Risk Families 222
9. ETHICAL AND LEGAL ISSUES 223
10. CONCLUSIONS 225
REFERENCES 225
Index 237