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Psychosis During Pregnancy: Treatment Considerations

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Annals of Clinical Psychiatry

Abstract

The onset of psychosis during pregnancy presents several difficult management decisions and a careful risk–benefit analysis is required. Withholding antipsychotic treatment may produce more risks than benefits. Studies on neuroleptic teratogenicity are contradictory. Most of the commonly used neuroleptics exhibit a pregnancy risk of category C. Neuroleptic use during pregnancy may be associated with adverse effects in the pre- and postnatal period. These concerns include compromising uterine blood flow, post-partum neonatal sedation, and extrapyramidal signs expressed in the neonate. Each neuroleptic exhibits a unique pharmacokinetic profile. The antipsychotic properties and side effects considered most significant include sedation, half-life, hypotension, and apparent hydrophilicity. In this case study a decision to select molindone was based on these parameters.

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REFERENCES

  1. Wisner KL, Peindl K, Hanusa BH: Symptomatology of affective and psychotic illnesses related to childbearing. J Affect Disorder 1994; 30:77–87

    Google Scholar 

  2. Nurnberg HG: An overview of somatic treatment of psychosis during pregnancy and postpartum. Gen Hosp Psychiatry 1989; 11:328–338

    Google Scholar 

  3. Mortola JF: The use of psychotropic agents in pregnancy and lactation. Psychiatr Clin North Am 1989; 12:69–87

    Google Scholar 

  4. Edlund MJ, Craig TJ: Antipsychotic drug use and birth defects: An epidemologic reassessment. Compr Psychiatry 1984; 25:32–37

    Google Scholar 

  5. Kopelman AE, McCullar FW, Heggeness L: Limb malformation following maternal use of haloperidol. JAMA 1975; 231:62–64

    Google Scholar 

  6. Hanson JW, Oakley GP: Haloperidol and limb deformity. JAMA 1975; 231:26 (letter)

    Google Scholar 

  7. Wan Waes A, Van De Velde E: Safety evaluation of haloperidol in the treatment of hyperemesis gravidarum. J Clin Pharmacol 1969; 9:224–227

    Google Scholar 

  8. Godet PF, Marie-Cardine M: Neuroleptiques, schizophrene et grosesse. L'Encephale 1991; 17:543–547

    Google Scholar 

  9. Anath J: Congenital malformations with psychopharmacologic agents. Compr Psychiatry 1975; 16:437–445

    Google Scholar 

  10. Moriarty AJ, Nance MR: Trifluoperazine and pregnancy. Can Med Assoc J 1963; 88:375–376 (letter)

    Google Scholar 

  11. Rumeau-Rouquette C, Goujard J, Huel G: Possible teratogenic effects of phenothiazine in human beings. Teratology 1977; 15:57–64

    Google Scholar 

  12. Milkovich L, Van Den Berg BJ: An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynenecol 1976; 125:244–248

    Google Scholar 

  13. Sobel DE: Fetal damage due to ECT, insulin, coma, chlorpromazine, or reserpine. Arch Gen Psychiatry 1960; 2:606–611

    Google Scholar 

  14. Wrede G, Mednick SA, Huttunen MO, Nilsson CG: Pregnancy and delivery complications in the births of an unselected series of Finnish children with schizophrenic mothers. Acta Psychiatr Scand 1980; 62:369–381

    Google Scholar 

  15. Auerbach JG, Hans SL, Marcus J, Maeir S: Maternal psychotropic medications and neonatal behavior. Neurotoxicol Teratol 1992; 14:339–406

    Google Scholar 

  16. Hill RM, Desmond MM, Kay JL: Extrapyramidal dysfunction in an infant of a schizophrenic mother. J Pediatr 1966; 69:589–595

    Google Scholar 

  17. Tamer A, McKey R, Arias D, Worley L, Fogel BJ: Phenothiazine-induced extrapyramidal dysfunction in the neonate. J Pediatr 1969; 75:479–480

    Google Scholar 

  18. Falterman CG, Richardson CJ: Small left colon syndrome associated with maternal ingestion of psychotropic drugs. J Pediatr 1980; 97:308–310

    Google Scholar 

  19. Scokel P, Jones WN: Infant jaundice after phenothiazines. Obstet Gynecol 1962; 20:124–127

    Google Scholar 

  20. Kris E: Children of mothers maintained on pharmacotherapy during pregnancy and postpartum. Curr Ther Res Clin Exp 1965; 7:785–789

    Google Scholar 

  21. Ayd FJ: Children born to mothers treated with chlorpromazine during pregnancy. Clin Med 1964; 71:1758–1763

    Google Scholar 

  22. Gelenberg AJ: Psychosis. In: Gelenberg AJ, Bassuk EL, Schoonover SC, eds. The Practitioner's Guide to Psychoactive Drugs, 3rd ed. New York: Plenum Press; 1991:125–178

    Google Scholar 

  23. Freedberg KA, Innis RB, Creese I, Snyder SH: Antischizophrenic drugs: differential plasma binding and therapeutic activity. Life Sci 1979; 24:2467–2474

    Google Scholar 

  24. Baldessarini RG: Drugs and the treatment of psychiatric disorders. In: Hardman JG, Limbird LE, Molinoff PG, Ruddon RW, Gilman AG, eds. Goodman and Gillman's the Pharmacologic Basis of Therapeutics, 9th ed. New York: McGraw-Hill; 1996:399–430

    Google Scholar 

  25. Briggs GG, Freeman RK, Yaffe SJ: Drugs in Pregnancy and Lactation, 4th ed. Baltimore: Williams and Wilkins; 1994

    Google Scholar 

  26. Nahas G, Gougard J: Phenothiazines, benzodiazepines and the fetus. In: Scarpelli EM, Cosmi ED, eds. Reviews in Perinatal Medicine. New York: Raven Press; 1979:243–280

    Google Scholar 

  27. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC: Williams Obstetrics, 19th ed. Norwalk, CT: Appleton and Lange; 1993:225–230

    Google Scholar 

  28. Oliver AP, Luchins DJ, Wyatt RJ: Neuroleptic induced seizures. An in vitro technique for assessing relative risk. Arch Gen Psychiatry 1982; 39:206–209

    Google Scholar 

  29. Gardos G, Cole JO: Weight reduction in schizophrenics by molindone. Am J Psychiatry 1977; 134:302–304

    Google Scholar 

  30. Parent MM, Roy S, Sramek J, Lawson W, Herrera J: Effect of molindone on weight change in hospitalized schizophrenic patients. Drug Intell Clin Pharm 1986; 20:873–875

    Google Scholar 

  31. Richelson ER: Neuroleptic affinities for human brain receptor and their use in predicting adverse effects. J Clin Psychiatry 1984; 45:331–336

    Google Scholar 

  32. Richelson ER: Pharmacology of neuroleptics in use in the United States. J Clin Psychiatry 1985; 46(8 sec 2):8–14

    Google Scholar 

  33. Jenkins SC, Hansen MR: A Pocket Reference for Psychiatrists, 2nd ed. Washington, DC: American Psychiatric Press; 1995:148

    Google Scholar 

  34. Ayd FJ: Moban: First of a new class of neuroleptics. In: Ayd FJ, ed. Rational Psychophamacotherapy and the Right to Treatment. Baltimore: Ayd Medical Communications; 1975:91–105

    Google Scholar 

  35. Janicak PG, Davis JM, Preskorn SH, Ayd FJ: Principles and Practice of Psychopharmacotherapy. Baltimore: Williams and Wilkins; 1993:481–484

    Google Scholar 

  36. Carpenter WT, Hanlon TE, Heinrichs DW, et al.: Continuous versus targeted medication in schizophrenic outpatients: outcomes results. Am J Psychiatry 1990; 147:1138–1148

    Google Scholar 

  37. Cohen BM, Babb S, Campbell A, Baldessarini RJ: Presistence of haloperidol in the brain. Arch Gen Psychiatry 1988; 45:879–880 (letter)

    Google Scholar 

  38. Sakalis G, Curry SH, Mould GP, Lader MH: Psychologic and clinical effects of chlopromazine and their relationship to plasma level. Clin Pharmacol Ther 1972; 13:931–946

    Google Scholar 

  39. Physicians' Desk Reference, 51st ed. Montvale: Medical Economics Data Production Company; 1997:1350, 2379

  40. Jann MW: Clozapine. Pharmacotherapy 1991; 11:179–195

    Google Scholar 

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Pinkofsky, H.B. Psychosis During Pregnancy: Treatment Considerations. Ann Clin Psychiatry 9, 175–179 (1997). https://doi.org/10.1023/A:1026234125565

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