A Review: Integrative Perspectives on the Features and Clinical Management of Psychotic Episodes in Pregnancy

Abstract

Psychotic episodes represent one of the most complex manifestations of various mental illnesses, and these encompass a wide variety of clinical manifestations that together lead to high morbidity in the general population. Various mental illnesses are associated with psychotic episodes; in addition, although their incidence and prevalence rates have been widely described in the general population, their correct identification and treatment is a challenge for health professionals in relation to pregnancy. In pregnant women, psychotic episodes can be the consequence of the manifestation of a previous psychiatric illness or may begin during the pregnancy itself, placing not only the mother, but also the fetus at risk during the psychotic episode. In addition, we cannot forget that both pharmacological and nonpharmacological management are complex given the different teratogenic effects of various neuroleptic drugs or mood stabilizers; moreover, the recommendation is that patients should be followed together with different specialists to maintain close contact during puerperium given the high incidence of recurrence of psychotic episodes. In addition, we cannot forget that a large portion of these patients for whom the onset times of such episodes are during pregnancy have a greater probability of an unpredictable psychiatric illness that requires a postpartum follow up, in addition to the postpartum psychotic episodes, at some point in their lives. Therefore, the purpose of this review is to summarize the epidemiology of psychotic breaks during pregnancy related to the main mental illnesses that affect this population and to summarize the main pharmacological treatments available for their clinical management.

Exploring the Role of Mediterranean and Westernized Diets and Their Main Nutrients in the Modulation of Oxidative Stress in the Placenta: A Narrative Review

“…Psychosis is a complex psychiatric disorder characterized by a loss of touch with reality, comprising delusions, hallucinations, and disorganized thought and behavior [105]. Although first-episode psychosis during pregnancy is a rare event, it is associated with adverse obstetric and neonatal outcomes such as cesarean delivery, impaired fetal growth, placental abruption, antepartum or postpartum hemorrhage, fetal anomalies, fetal distress, and stillbirth [106].…”

Manejo clínico da psicose durante a perinatalidade

“…Episódios mal gerenciados desse transtorno, que é tido como uma emergência psiquiátrica grave, aumentam o risco de acidentes materno-infantis e de autoextermínio (FORDE R, et al, 2019). Durante a gestação, é importante destacar ainda as repercussões para o desenvolvimento fetal e a possibilidade aumentada de desfechos obstétricos e neonatais reservados, como o descolamento prematuro da placenta, anomalias, natimortalidade e hemorragias pré e pós-parto (ORTEGA MA, et al, 2023). A prevalência aproximada de episódios psicóticos e de psicose na população é de 3% da população (MCCLEERY A e NUECHTERLEIN KH, 2019), afetando entre 1 e 2 a cada 1000 mulheres durante o puerpério (PERRY A, et al, 2021).…”

Assessment of Tissue Expression of the Oxytocin–Vasopressin Pathway in the Placenta of Women with a First-Episode Psychosis during Pregnancy

“…FEP can lead to long-term consequences affecting the wellbeing of the woman, the newborn, her family, and wider society [ 11 ]. Despite this, there is little knowledge about the pathophysiology of FEP, and its management remains challenging for clinicians, who must take into consideration the benefits and harms [ 12 ].…”