Understanding and Treating Women with Schizophrenia during Pregnancy and Postpartum

Abstract

This  article  provides   a  synopsis   of  clinically relevant  data  pertaining  to sexuality,  pregnancy, the postpartum period, parenting and family planning in women with schizophrenia.  Based on this information, we propose recommendations for the non-pharmacological management of these patients.  Along with the deinstitutionalization  of people with severe and persistent  mental illness, there  has  been  a concurrent  increase  in relative fertility in women with schizophrenia. Understanding  the nature and experience  of sexuality in women with schizophrenia helps elucidate the context in which pregnancies occur. Schizophrenia does not diminish sexual desire or activity.   However,   the   quality   and   relational context  of sexuality  may be markedly different. Pregnancy appears to worsen mental health in a subset of women with schizophrenia. Psychotic denial of pregnancy is a symptom that poses especially high risks for poor outcomes if not addressed.  Psychoeducation  can reduce  the risks of   pregnancy   complications   for   women   with schizophrenia. Short-term, focused psychotherapy can be useful for some pregnant women with schizophrenia.   Some  modifications   need  to  be made   in   the   inpatient   treatment   of   pregnant patients with schizophrenia. In the postpartum period,  women can be especially susceptible  for acute exacerbation of their schizophrenia. With regards  to parenting,  many  women  will  provide intermittent   parenting  for  their  children  while others will lose custody of their children. Those mothers with schizophrenia who do raise their children may face unique challenges in parenting. Both  positive  and  negative  symptoms  can interfere with the demands of being a parent. A comprehensive parenting assessment of the patient  can provide  guidance  for the implementation  of supportive  services.  Proactive family planning could reduce the high rate of unwanted pregnancies, as women with schizophrenia  tend  to  have  more  limited knowledge of their contraceptive options.