Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-19T09:14:46.723Z Has data issue: false hasContentIssue false

20 - Psychiatric disorders in pregnancy

from Section 5 - Other disorders

Published online by Cambridge University Press:  19 October 2009

By
Timothy J. G. Pavy
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Timothy J. G. Pavy
Affiliation:
Staff Specialist, Anaesthetist and Head of Department, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, Subiaco, Western Australia
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
Get access

Summary

Introduction

The peak incidence of affective disorders in women occurs at 23 to 44 years of age, which coincides with the prime child bearing years. Pregnancy and childbirth represent major life stresses, as well as a time of fundamental psychological and social change. The experience of childbirth constitutes a major mental health hazard for women, with an estimated fivefold increase in the appearance of mental illness in the year following childbirth. Women who are pregnant, or have recently given birth, may experience relapses of earlier mental disease or develop a new disorder. Women with psychiatric disorders become pregnant and their psychiatric condition can present management problems at different stages of pregnancy. Less commonly, previously well women may develop a major psychiatric disturbance during or after pregnancy, which may or may not herald a chronic condition. Many of these individuals take medications that have the potential to interact with anesthetic agents and other drugs. These women require considerable tact and skill on the part of their attendants.

The first three years of a consultation-liaison psychiatry service to an obstetric inpatient unit in an Australian hospital had a referral rate of 1.2% of obstetric admissions, totalling 90 consultations over three years. The commonest DSM-III-R psychiatric diagnoses were personality disorders (19%), mood disorders (17%), schizophrenic disorders (15%), and adjustment disorders. Reasons for referral included coping problems, depression, anxiety or fear, and a history of major psychiatric illness.

Obstetric anesthesiologists may have their management skills tested with women who have personality disorders.

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 363 - 370
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Oates, M. R.The treatment of psychiatric disorders in pregnancy and the puerperium. Clin. Obstet. Gynaecol. 1986; 13: 385–95.Google Scholar
Dunsis, A. & Smith, G. C.Consultation-liaison psychiatry in an obstetric service. Aust. N. Z. J. Psychiatry 1996; 30: 63–73.Google Scholar
Coyle, I., Wayner, M. J. & Singer, G.Behavioural teratogenesis: a critical evaluation. Pharmacol. Biochem. Behav. 1976; 4: 191–200.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association 1994.
Pickar, D.Prospects for pharmacotherapy of schizophrenia. Lancet 1995; 345: 557–62.Google Scholar
Goldberg, H. L. & Nissim, R.Psychotropic drugs in pregnancy and lactation. Int. J. Psychiatry Med. 1994; 24: 129–47.Google Scholar
Rumeau-Rouquette, C., Goujard, J. & Huel, J.Possible teratogenic effects of phenothiazines in human beings. Teratology 1977; 15: 57–64.Google Scholar
Kuller, J. A., Katz, V. L., McMahon, M. J., Wells, S. R. & Bashford, R. A.Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects. Obstet. Gynecol. 1996; 87: 789–94.Google Scholar
Miller, L. J.Clinical strategies for the use of psychotropic drugs during pregnancy. Psychiatr. Med. 1991; 9: 275–98.Google Scholar
Wood, M. & Wood, A. J. J.Drugs and Anesthesia, 2nd edn. Baltimore: Williams and Wilkins, 1990.
Pankratz, W. J.Electroconvulsive therapy: the position of the Canadian Psychiatric Association. Can. J. Psychiatry 1980; 25: 509–14.Google Scholar
Varan, L. R., Martin, S., Gillieson, M. S., Skene, D. S. & Sarwer-Foner, G. J.ECT in an acutely psychotic pregnant patient with actively aggressive (homicidal) impulses. Can. J. Psychiatry 1985; 30: 363–7.Google Scholar
DeBattista, C., Cochran, M., Barry, J. J. & Brock-Utne, J. G.Fetal heart rate decelerations during ECT- induced seizures: is it important?Acta Anaesthesiol. Scand. 2003; 47: 101–3.Google Scholar
Cohen, L. S., Heller, V. L. & Rosenbaum, J. F.Treatment guidelines for psychotropic drug use in pregnancy. Psychosomatics 1989; 30: 25–33.Google Scholar
Bennett, H. A., Einarson, A., Taddio, A., Koren, G. & Einarson, T.Prevalence of depression during pregnancy: systematic review. Obstet. Gynecol. 2004; 103: 698–709.Google Scholar
Kramer, P. D.Against Depression. New York: Viking Penguin, 2006.
Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M. & Bixo, M.Implications of antenatal depression and anxiety for obstetric outcome. Obstet. Gynecol. 2004; 104: 467–76.Google Scholar
Bonari, L., Pinto, N., Ahn, E.et al. Perinatal risks of untreated depression during pregnancy. Can. J. Psychiatry 2004; 49: 726–35.Google Scholar
Cohen, L. S., Nonacs, R. M., Bailey, J. W.et al. Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study. Arch. Womens Ment. Health 2004; 7: 217–21.Google Scholar
Lamberg, L.Risks and benefits key to psychotropic use during pregnancy and postpartum period. J.A.M.A. 2005; 294: 1604–8.Google Scholar
Jacobson, S. J., Jones, K., Johnson, K.et al. Prospective multicenter study of pregnancy outcome after lithium exposure during first trimester. Lancet 1992; 339: 530–3.Google Scholar
Cohen, L. S., Friedman, J. M., Jefferson, J. W., Johnson, E. M. & Weiner, M. L.A reevaluation of risk of in utero exposure to lithium. J.A.M.A. 1994; 271: 146–50.Google Scholar
Idanpaan-Heikkila, J. & Saxen, L.Possible teratogenicity of imipramine/chloropyramine. Lancet 1973; 2: 282–4.Google Scholar
Altshuler, L. L. & Szuba, M. P.Course of psychiatric disorders in pregnancy: dilemmas in management. Neurol. Clin. 1994; 12: 613–35.Google Scholar
Kingston, M. E.Hyperventilation in tricyclic antidepressant poisoning. Crit. Care Med. 1979; 7: 550–1.Google Scholar
Brown, T. C. K., Barker, G. A., Dunlop, M. E. & Loughnan, P. M.The use of sodium bicarbonate in the treatment of tricyclic antidepressant-induced arrhythmias. Anaesth. Intensive Care 1973; 1: 203–10.Google Scholar
Cooper, D. J.Acidosis and sodium bicarbonate therapy. Australasian Anaesthesia 1994, p39–48. Australian and New Zealand College of Anaesthetists. Printed by Bridge Printery, 29–35 Dunning Ave, Rosebury NSW 2018.Google Scholar
Grimsley, S. R. & Jann, M. W.Paroxetine, sertraline and fluvoxamine: new selective serotonin reuptake inhibitors. Clin. Pharm. 1992; 11: 930–57.Google Scholar
Pastuszak, A., Schick-Boschetto, B., Zuber, C.et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). J.A.M.A. 1993; 269: 2246–8.Google Scholar
Chambers, C. D., Johnson, K. A., Dick, L. M., Felix, R. J. & Jones, K. L.Birth outcomes in pregnant women taking fluoxetine. N. Engl. J. Med. 1996; 335: 1010–15.Google Scholar
Robert, E.Treating depression in pregnancy (editorial). N. Engl. J. Med. 1996; 335: 1056–8.Google Scholar
Howard, L. M., Hoffbrand, S., Henshaw, C., Boath, L. & Bradley, E.Antidepressant prevention of postnatal depression. Cochrane Database Syst. Rev. 2005; 2: CD004363.Google Scholar
Altshuler, L. L., Burt, V. K., McMullen, M. & Hendrick, V.Breastfeeding and sertraline: a 24-hour analysis. J. Clin. Psychiatry 1995; 56: 243–5.Google Scholar
Hale, A. S.Recent advances in the treatment of depression. Br. J. Hosp. Med. 1996; 55: 183–6.Google Scholar
Henry, J. A.Antidepressants and overdoses. Postgrad. Med. J. 1994; 70: S9–12.Google Scholar
Corkeron, M. A.Serotonin syndrome – a potentially fatal complication of antidepressant therapy. Med. J. Aust. 1995; 163: 481–2.Google Scholar
Kallen, B.Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch. Pediatr. Adolesc. Med. 2004; 158: 307–8.Google Scholar
Zeskind, P. S & Stephens, L. E.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn behavior. Pediatrics 2004; 113: 368–75.Google Scholar
Shee, J. C.Dangerous potentiation of pethidine by iproniazid, and its treatment. Br. Med. J. 1960; 5197: 507–9.Google Scholar
Vigram, I. M.Dangerous potentiation of meperidine hydrochloride by pargyline hydrochloride. J.A.M.A. 1964; 187: 953–4.Google Scholar
Stack, C. G., Rogers, P. & Linter, S. P.Monoamine oxidase inhibitors and anaesthesia. A review. Br. J. Anaesth. 1988; 60: 222–7.Google Scholar
Stockley, I. H.Drug Interactions: A Source Book of Adverse Interactions, Their Mechanisms, Clinical Importance and Management. Oxford: Blackwell Scientific Publications, 1981.
Boakes, A. J., Laurence, D. R., Teoh, P. C.et al. Interactions between sympathomimetic amines and antidepressant agents in man. Br. Med. J. 1973; 1: 311–15.Google Scholar
Pavy, T. J., Kliffer, A. P. & Douglas, M. J.Anaesthetic management of labour and delivery in a woman taking long-term MAOI. Can. J. Anaesth. 1995; 42: 618–20.Google Scholar
Sternbach, H.The serotonin syndrome. Am. J. Psychiatry 1991; 148: 705–13.Google Scholar
McFarlane, H. J.Anaesthesia and the new generation monoamine oxidase inhibitors. Anaesthesia 1994; 49: 597–9.Google Scholar
Lonnqvist, J., Sintonen, H., Syvälahti, E.et al. Antidepressant efficacy and quality of life in depression: a double-blind study with meclobemide and fluoxetine. Acta Psychiatr. Scand. 1994; 89: 363–9.Google Scholar
Amrein, R., Guntert, T. W., Dingemanse, J.et al. Interactions of moclobemide with concomitantly administered medication: evidence from pharmacological and clinical studies. Psychopharmacology 1992; 106: S24–31.Google Scholar
Ferrill, M. J., Kehoe, W. A. & Jacisin, J. J.ECT during pregnancy: physiologic and pharmacologic considerations. Convuls. Ther. 1992; 8: 186–200.Google Scholar
Miller, L. J.Use of electroconvulsive therapy during pregnancy. Hosp. Community Psychiatry 1994; 45: 444–50.Google Scholar
Fink, M.Meduna and the origins of convulsive therapy. Am. J. Psychiatry 1984; 141: 1034–41.Google Scholar
Passione, R.Italian psychiatry in an international context: Ugo Cerletti and the case of electroshock. Hist. Psychiatry 2004; 15: 83–104.Google Scholar
Goldstein, H. H., Weinberg, J. & Sankstone, M. I.Shock therapy in psychosis complicating pregnancy, a case report. Am. J. Psychiatry 1941; 98: 201–2.Google Scholar
Sherer, D. M., D'Amico, M. L., Warshal, D. P.et al. Recurrent mild abruptio placentae occurring immediately after repeated electroconvulsive therapy in pregnancy. Am. J. Obstet. Gynecol. 1991; 165: 652–3.Google Scholar
Balki, M., Castro, C. & Ananthanarayan, C.Status epilepticus after electroconvulsive therapy in a pregnant patient. Int. J. Obstet. Anesth. 2006; 15: 325–8.Google Scholar
Klein, D. F.Delineation of two drug-responsive anxiety syndromes. Psychopharmacologia 1964; 17: 397–408.Google Scholar
George, D. T., Ladenheim, J. A. & Nutt, D. J.Effect of pregnancy on panic attacks. Am. J. Psychiatry 1987; 144: 1078–9.Google Scholar
Carey, G. & Gottesman, I. I. Twin and family studies of anxiety, phobic and obsessive disorders. In Klein, D. F. & Rabkin, J. G. (eds.), Anxiety: New Research and Changing Concepts. New York: Raven Press, 1981.
Fawcett, J.Suicide risk factors in depressive disorders and in panic disorders. J. Clin. Psychiatry 1992; 53: S9–13.Google Scholar
Buigues, J. & Vallejo, J.Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks. J. Clin. Psychiatry 1987; 48: 55–9.Google Scholar
Rosenberg, L., Mitchell, A. A., Parsells, J. L.et al. Lack of relation of oral clefts to diazepam use during pregnancy. N. Engl. J. Med. 1983; 309: 1282–5.Google Scholar
Rubinchik, S. M., Kablinger, A. S. & Gardner, J. S.Medications for panic disorder and generalized anxiety disorder during pregnancy. Prim. Care Companion J. Clin. Psychiatry 2005; 7: 100–5.Google Scholar
Spreight, A. N.Floppy infant syndrome and maternal diazepam and/or nitrazepam. Lancet 1977; 2: 878.Google Scholar
O'Meara, M. E. & Gin, T.Comparison of 0.125% bupivacaine with 0.125% bupivacaine and clonidine as extradural analgesia in the first stage of labour. Br. J. Anaesth. 1993; 71: 651–6.Google Scholar
Pritchard, D. B. & Harris, B.Aspects of perinatal psychiatric illness. Br. J. Psychiatry 1996; 169: 555–62.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Psychiatric disorders in pregnancy
    • By Timothy J. G. Pavy, Staff Specialist, Anaesthetist and Head of Department, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, Subiaco, Western Australia
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.021
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Psychiatric disorders in pregnancy
    • By Timothy J. G. Pavy, Staff Specialist, Anaesthetist and Head of Department, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, Subiaco, Western Australia
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.021
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Psychiatric disorders in pregnancy
    • By Timothy J. G. Pavy, Staff Specialist, Anaesthetist and Head of Department, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, Subiaco, Western Australia
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.021
Available formats
×