Can A Woman “Get Mad” During Pregnancy Or Is Something Else Missing?
The terminology concerning psychiatric problems is characterized by considerable ambiguity, both in a general context and during the period of pregnancy.
The obstetrician must have the judgment and the ability to identify the problem in time (if possible from the first visit) and to refer the patient immediately to a psychiatrist. The pregnant woman might have a known psychiatric history or have her first episode during pregnancy, which usually appears in the setting of a pre-existing undiagnosed disorder.
Thymic Disorders
These include episodes of depression, mania, and mixed episodes (manic depression). They are not a disease in themselves but part of a monopolar or bipolar disorder. An episode of depression is considered at least two weeks lasting, with loss of mood, and pleasure at all levels.
Seven categories of criteria have been established, of which at least four must be met: weight loss, anorexia, daily insomnia or drowsiness, hyperactivity or lack of mood for any movement, fatigue, and loss of energy. Also, there are often ideas of guilt or self-esteem, indecision, inability to concentrate, and finally ideas of death or suicidal tendencies.
It should be clarified that some pathological diseases, such as hypothyroidism, can create a similar clinical picture. For this reason, a thyroid function test should be performed, in case of suspected depression.
Also, as mentioned, there might be a manifestation of bipolar disease during pregnancy or even a simple manic episode. However, the period after a child’s birth is considered a higher risk. Both manic and depressive episodes need to be closely monitored because the risk of harm to the mother and fetus is increased.
Schizophrenia And Other Psychotic Disorders
Psychosis during pregnancy is six times less common compared to the postpartum period. The onset time during labor can be two weeks after delivery and in 80% of cases within the first month after delivery. Women with a history are more likely to develop the disease, both during and immediately after pregnancy.
A key feature of schizophrenia is the great disturbance in the perception of reality. Of course, a similar clinical picture can appear in other conditions, such as while being in the use of various addictive substances, in dementia, but also under major episodes of depression or mania. The definition used today refers to episodes of hallucinations, delirium, disorganized thinking, or behavior lasting from one day to one month, followed by complete remission.
Women with this problem usually had the disease before becoming pregnant. They were probably under neuroleptic drugs, which have a low teratogenic effect. The most important point for pregnant women is that pregnancy, childbirth, and the postpartum period are going to burden them with even more stress.
Most patients in this category do not comply with the treatment, which makes it necessary for the gynecologist to cooperate with the psychiatrist for as meticulous observance as possible.
Anxiety Disorders
These include various phobias (e.g. agoraphobia), panic disorders, panic attacks, etc. Panic attacks can also be part of the clinical picture of the most severe mono-/ bipolar conditions. Their duration usually does not exceed half an hour.
Therapeutic strategies include supportive behavioral psychotherapy and medication. Benzodiazepines should be avoided in the first trimester of pregnancy or if necessary should be used with extreme caution.
Disorders Due To Substance Use
These are the most common psychiatric disorders observed in pregnancy. More than 100 are listed in the literature: from alcoholic dementia to sexual dysfunction of opiate users. The addictive substances are divided into 11 categories: alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, and sleeping pills.
The most common condition is alcoholism, which can cause “fetal alcohol syndrome” in the fetus. One-third of infants born by alcoholic mothers have congenital anomalies; four times the frequency of infants whose mothers did not consume alcohol at all. Alcoholism can also cause problems in the pregnant woman herself, such as accidents, liver problems, dementia, and suicidal tendencies.
Pregnant heroin users are a recent, very common category. These women should be urgently admitted to a methadone detox program, at least throughout their pregnancy. Methadone is considered to be less dangerous than heroin during pregnancy. It is always useful to measure the levels of these substances in the blood. Pregnancy can be complicated by delayed fetal development, preeclampsia, premature birth but also by all the consequences of substance use, such as abscesses, thrombophlebitis, septic pulmonary embolism, HIV, HBV, HCV, etc.
Fetuses of mothers addicted to cocaine show: slowing of intrauterine growth, microcephaly, digestive and urinary disorders, intracranial hemorrhage and are more prone to sudden neonatal death.
In general, pregnant women who use addictive substances are more likely to develop: delayed intrauterine growth, preeclampsia, premature rupture of fetal membranes (PRE), premature placental abruption, premature birth, HIV, HBV, HCV, preterm, hip umbilical cord.
After birth, newborns may be irritable, have tremors, convulsions, shortness of breath, vomiting, diarrhea, and sleep disturbances.
Immediate, timely, and effective detoxification treatment, even for short periods, has an obvious effect on both the quality of life of the mother and the health of the fetus.
