Atypical Antipsychotics in the Treatment of Schizophrenia During Pregnancy and the Postpartum

Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Ángeles, California, United States
American Journal of Psychiatry (Impact Factor: 13.56). 01/2007; 163(12):2064-70. DOI: 10.1176/appi.ajp.163.12.2064
Source: PubMed
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    • "The woman and her partner decided that her mental health was, on balance, as important as the well-being of the foetus and, despite the lack of research available; the decision was made to resume treatment with quetiapine with good result. Overall in reports regarding the safety of quetiapine in pregnancy most studies report no adverse effects (Yaegar et al. 2006) or congenital abnormalities (Tenyi et al. 2002, Taylor et al. 2003, McKenna et al. 2005, Gentile 2006b). "
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    ABSTRACT: Women who are pregnant and who have a history of psychosis are commonly managed with antipsychotic medications. The evidence regarding the use of antipsychotics in pregnancy has been insufficient to provide adequate support for this practice and is a concern for clinicians and women alike. This review presents literature surrounding the use of antipsychotic medications in pregnancy, providing an overview of the historical and contemporary perspectives which influence clinicians prescribing practices. Data were sourced from Medline, CINAHL, PsycINFo, using the terms antipsychotics with pregnancy and psychosis or schizophrenia. This was expanded to include the most common atypical antipsychotics: olanzapine, risperidone, clozapine, quetiapine, ziprasidone and aripiprazole. Literature was found reporting the use of antipsychotic medications in pregnancy since the introduction of antipsychotics in the 1950s, comprising mainly of authors' reviews of the literature, case studies, retrospective reports, drug company registries and more recently a prospective comparative study. This review identifies that the literature provides no clear answer for clinicians as to the risk associated with the use of antipsychotics in pregnancy. To this effect, recently in Australia, the National Register of Antipsychotic Medications in Pregnancy was established to prospectively collect information regarding outcomes for mother and baby, when antipsychotic medications have been used during pregnancy.
    Journal of Psychiatric and Mental Health Nursing 03/2010; 17(2):97-104. DOI:10.1111/j.1365-2850.2009.01481.x · 0.98 Impact Factor
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    • "The relatively selective receptor blockade effects of these two drugs provide advantages to further dissect the underlying mechanism of the neurobehavioral dysfunction in offspring after prenatal exposure to antipsychotic drugs. Neither RIS nor SUL has been associated with tetrogenicity in animals as well as in humans (Costa et al., 2004; Trixler et al., 2005; Yaeger et al., 2006). SUL has been suggested to lead to cognitive deficits in human volunteers (Mehta et al., 1999). "
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    ABSTRACT: Antipsychotic treatment during pregnancy is indicated when risk of drug exposure to the fetus is outweighed by the untreated psychosis in the mother. Although increased risk of congenital malformation has not been associated with most available antipsychotic drugs, there is a paucity of knowledge on the subtle neurodevelopmental and behavioral consequences of prenatal receptor blockade by these drugs. In the present study, antipsychotic drugs, sulpiride (SUL, a selective D2 receptor antagonist) and risperidone (RIS, a D2/5HT2 receptor antagonist) were administered to pregnant Sprague-Dawley dams from gestational day 6 to 18. Both RIS and SUL prenatal exposed rats had lower birth body weights compared to controls. RIS exposure had a significant main effect to retard body weight growth in male offspring until postnatal day (PND) 60. Importantly, water maze tests revealed that SUL prenatal exposure impaired visual cue response in visual task performance (stimulus-response, S-R memory), but not place response as reflected in hidden platform task (spatial memory acquisition and retention). In addition, prenatal SUL treatment reduced spontaneous activity as measured in open field. Both behavioral deficits suggest that SUL prenatal exposure may lead to subtle disruption of striatum development and related learning and motor systems. RIS exposure failed to elicit deficits in both water maze tasks and increased rearing in open field test. These results suggest prenatal exposure to SUL and RIS may produce lasting effects on growth, locomotion and memory in rat offspring. And the differences may exist in the effects of antipsychotic drugs which selectively block dopamine D2 receptors (SUL) as compared to second generation drugs (RIS) that potently antagonize serotonin and dopamine receptors.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 03/2008; 32(2):387-97. DOI:10.1016/j.pnpbp.2007.09.005 · 4.03 Impact Factor
  • Nursing for Women s Health 01/2011; 14(6):482-94; quiz 495.
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