Managing psychosis in pregnancy

OBJECTIVE: This article provides an introduction to the complex issues surrounding the management of women who have a history of psychosis and who become pregnant. Balancing the mental wellbeing of the woman and the safety and wellbeing of the baby is a complex task for both the expectant mother and the health professionals involved in her care. CLINICAL PICTURE: Within this article the complexity of the issues will be outlined as a case report of a woman with a history of psychotic related disorders, who was also pregnant. TREATMENT: The woman was being case managed by a Mental Health Service in Victoria, Australia, and was included on the National Register of Antipsychotic Medications in Pregnancy Register (NRAMP) recently established at the Alfred Psychiatry Research Centre (APRC). OUTCOME: The profile of women with a history of previous mental illness, and who are pregnant, often includes a poor psychosocial history and involvement with child protection agencies with regard to custody of the children. Well meant but poorly coordinated decisions by health professionals result in sub-optimal outcomes for both mother and infant. CONCLUSION: There is a need for the exploration of the management and experiences of women who have a history of psychosis and who are pregnant. This case example highlights the complexity of issues surrounding the management of this vulnerable group of women and their babies.