Critical Issues in Perinatal Psychiatric Emergency Care

By Linda H. Chaudron, MD, MS | May 1, 2006


Table 2 Risks and benefits of psychiatric treatment during pregnancy
	Risks	Treatment options

	• Untreated mental illness Safety of the mother (self-harm, suicidality) Safety of fetus (self-induced termination) Malnutrition Refusal of prenatal care Precipitate or premature delivery Drug and alcohol(Drug information on alcohol) use Over-the-counter/herbal self-treatment Low birth weight Long-term effects of anxiety/hypothalamic-pituitary-adrenal axis changes on fetus/child • Medication Physical anomalies (major and minor) Behavioral teratogenicity Cognitive/neurologic development Maternal side effects Pregnancy loss Fetal/neonatal withdrawal and toxicity • Alternatives Electroconvulsive therapy Hospitalization	• No treatment • Psychotherapy • Prescription medication • Combination psychotherapy and medication • Hospitalization—inpatient or partial • Electroconvulsive therapy • Alternative treatments, such as light therapy, omega-3 fatty acids What affects and guides the decisions? • Patient’s wishes and fears • Severity of current illness • Medication(s) needed Monotherapy versus polytherapy High-risk versus low-risk medication Dose required As-needed versus continuous use • Patient’s psychiatric history Severity Recurrences when untreated Treatment response • Patient’s triggers • Family, partner support/opinions about treatment • Ob/gyn, pediatrician opinions about treatment

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Drugs Mentioned in This Article

Amitriptyline (Elavil, Endep)
Aripiprazole (Abilify)
Carbamazepine (Carbatrol, Tegretol, others)
Citalopram (Celexa)
Fluoxetine (Prozac)
Lamotrigine (Lamictal)
Lithium (Eskalith)
Nortriptyline (Aventyl, Pamelor)
Olanzapine (Zyprexa)
Paroxetine (Paxil)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Sertraline (Zoloft)
Valproic acid (Depakote, Valproate, others)
Venlafaxine (Effexor)
Ziprasidone (Geodon)

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Critical Issues in Perinatal Psychiatric Emergency Care

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