Schizophrenia in pregnancy

Question 1

20F with schizophrenia well managed on Aripiprazole, live with family and not working. She has come to see you for new script, and you are her GP. She says that she is now pregnant and planning to move out with her boyfriend. what are the important issues and what is your management plan?

Answer 1

Impression
Key issue is the use of atypical antipsychotics in pregnancy, and effective management of the patient’s mental health across the period of pregnancy to optimise mother and baby’s health.

Key biopsychosocial factors to consider/address

• pharmacological mx during pregnancy
• patient’s mental illness across
• moving in with boyfriend - social stressors and support network

Question 2

Schizophrenia in pregnancy - Assessment

Answer 2

Assessment
- Would conduct full psychiatric assessment to document patient’s current mental state.

• Psychiatric history
• LMP, pregnancy history, SNAP,
• MSE
• Systems review + baseline measurements to observe for any adverse effects of antipsychotic use
• Baseline investigations (ECG, basic bloods)

Question 3

Schizophrenia in pregnancy - Pharm discussion

Answer 3

Pharm discussion

• Epidemiological data suggests that antipsychotics aren’t associated with an increased risk of congenital malformations
• however, antipsychotics do have significant adverse effects profile (NMS, hyperprolactinaemia, sedation, cardiac toxicity, qTC prolongation, EPSE)
• would want to avoid antipsychotics with significant metabolic side effects (olanzapine, etc)
• want to institute regular patient reviews to monitor for any symptoms relapse early in order to prevent complications associated with worsening mental illness.

Question 4

Schizophrenia in pregnancy - social discussion

Answer 4

Social discussion

• Would want to discuss support networks throughout pregnancy, plans for home situation and moving circumstances
• Availability for regular reviews with GP

Question 5

Schizophrenia in pregnancy - Management

Answer 5

Management
Non-pharmacological
- lifestyle interventions
- dietary mods as necessary
- arrange additional social supports as necessary

Pharmacological

• keep same medication given sx well controlled, just for regular review
• psychiatrist referral

Safety-netting/review

• sx to look out for (palpitations, abnormal movements,
• institute regular review
• O&G referral for review and planning