Treatment of psychosis during pregnancy - a case report and a mini-review

Nielsen RE. Treatment of psychosis during pregnancy - a case report and a mini-review. Objective: Describe clinical problems in treating a patient with psychotic symptoms during pregnancy by presenting a case report, and review the current evidence on antipsychotic drugs during pregnancy. Methods: The review consists of a non-systematic clinical review of current data on treatment with antipsychotics during pregnancy. The case, a 27 year old female initially diagnosed with posttraumatic stress disorder (PTSD) after a rape and emotionally unstable personality disorder, illustrates some of the common challenges a clinician meets. The patient initially discontinues all treatment as she is unsure if the drugs could have a teratogenic effect and is changed to a treatment that is regarded as safe during pregnancy. Results: The current data supports treatment with chlorpromazine although there is a risk of side effects, e. g. extrapyramidal symptoms and hypotension, but also treatment with olanzapine and risperidone. If the patient is currently treated with clozapine, this treatment should be continued, due to clozapines unique efficacy profile. Blood monitoring for six months after birth is recommended when the newborn has been exposed to clozapine treatment. Conclusion: Current evidence on treatment with antipsychotics during pregnancy is sparse, but not treating is associated with increased risks compared to treatment.