The perinatal period is a vulnerable time for the acute onset and recurrence of psychiatric illness. Primary care providers are opportunely positioned to intervene for women who present with mood decompensation, excessive anxiety, or psychosis during the perinatal period. Owing to increased screening efforts in obstetrical clinics and amount of contact during the perinatal period, obstetricians may be able to identify patients who need treatment before their symptoms become severe. In this article, we address imminent and emergent psychiatric symptoms in the perinatal period including management and risk reduction to help obstetrician/gynecologists treat and/or refer patients as clinically appropriate.
Schizophrenia I Psychosis I Cannabis use disorder I Psychosocial treatment I Pharmacological treatment Opinion statement Cannabis is used by more than 25 % of schizophrenia patients and is associated with symptom exacerbation and poorer clinical outcome. To date, evidence is scarce for treating cannabis use disorders among schizophrenia patients. Psychosocial interventions such as cognitive behavioral therapy, motivational interviewing, or contingency management have been evaluated as potential treatments for cannabis use disorders (CUD) among schizophrenia patients and in the general population. However, results are somewhat inconsistent, and efficacy appears to wane after treatment concludes. Pharmacotherapy has also been examined as a potential treatment for CUD but has not yet demonstrated consistent efficacy in the general population. The administration of second-generation antipsychotic medications is the pharmacological standard of care for schizophrenia as well as the treatment of choice for comorbid cannabis use among schizophrenia patients. Recent preliminary trials of pharmacotherapy agents in the general population must be further tested to confirm their potential efficacy at treating CUD. Based on the current evidence, we recommend a multi-faceted approach to treatment for CUD in the schizophrenia population, employing pharmacological and psychosocial modalities. We recommend using a second-generation antipsychotic medication; to date risperidone, olanzapine, and clozapine show the most promise for this population. We also recommend engaging patients in a combination of motivation-based treatment (motivational interviewing or motivation enhancement therapy) and cognitive behavioral treatment directed at cannabis use. When family systems allow, multidimensional family therapy should also be considered, particularly for adolescent patients. The available evidence suggests that CUDs will require ongoing treatment in order to maintain long-term efficacy.
INTRODUCTION: There is not much data on the management of perinatal psychiatric emergencies in the current literature despite the increased attention that they have received in the media recently. This presentation will provide the data that is currently available, including a retrospective analysis of our own institution, and provide guidelines to direct clinical care. METHODS: A literature search was performed to analyze all of the available published data on perinatal psychiatric emergencies. Also, a retrospective data analysis was performed at our own university hospital looking at use of restraints, psychotropic medications, and or both in the treatment of pregnant women who presented to the emergency department. Data on chief complaint, demographics, and final disposition were also analyzed. RESULTS: The data is still being analyzed but a good proportion received psychotropics and went on to be psychiatrically hospitalized. Restraints were a rare event. According to the literature search, some conclusions can be drawn as to which medications and treatments may be less risky for certain emergencies. Of note, there were a considerable number of patients whose chief complaint was medical but ultimately were psychiatrically assessed and admitted. CONCLUSION: This is, to our knowledge, the first retrospective analysis of emergency room data on the management of perinatal psychiatric emergencies. These data will be the basis for future research in this field which deserves more attention due to the dearth of information currently available.
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