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: 12.3). 01/2007; 163(12):2064-70. DOI: 10.1176/appi.ajp.163.12.2064
Source: PubMed

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    • "The American Congress of Obstetricians and Gynecologists recommends continuing pharmacotherapy during pregnancy because severe psychiatric episodes are generally thought to be caused by discontinuation of medication.10–12 Some experts consider the risk associated with first-generation antipsychotic agents, which have been available for decades, to be less than the risk associated with selected mood stabilizers.13,14 However, in the case of atypical antipsychotics, it is difficult to draw any definitive conclusions due to a paucity of reproductive safety data,15 so routine use is not recommended during pregnancy. "
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    ABSTRACT: Women with bipolar disorder have a high risk for symptom exacerbation during pregnancy and the risk is elevated further when mood stabilizers are discontinued. This report describes a 31-year-old bipolar woman who discontinued medication before pregnancy but had to resume her pharmacotherapy due to manic episodes that recurred during the second trimester. Olanzapine, an atypical antipsychotic, was administered from week 25 of gestation and then replaced with quetiapine in week 35 of gestation. Even though a consensus on clinical interventions for pregnant patients with symptom relapse has not been reached, clinicians should still discuss pregnancy and therapeutic management with every female bipolar patient of childbearing age. This discussion is important because treatment can be managed most effectively in these individuals if pregnancy is planned. Ultimately, clinical decisions should be made on a case-by-case basis, weighing the risks to the mother and fetus between the disorder itself and the teratogenicity of pharmacotherapy.
    Full-text · Article · Feb 2014 · Neuropsychiatric Disease and Treatment
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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.
    Full-text · Article · Mar 2010 · Journal of Psychiatric and Mental Health Nursing
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    • "Safety of flupenthixol in pregnancy has not been established though no major malformations have been reported. However, it has been recommended that depot neuroleptics should be avoided in pregnancy unless absolutely essential.[26] If your patient is compliant with medication, you should consider an antipsychotic whose safety profile is well established such as haloperidol. "
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    ABSTRACT: Women in childbearing age frequently suffer from mental illness. Maternal psychiatric disorders may have a devastating impact on the fetus and the newborn. Thus treating or preventing relapse of these disorders during pregnancy and puerperium is a clinical and ethical duty with the necessity to avoid or minimize fetal or neonatal drug exposure. Though there are many guidelines and comprehensive reviews regarding drug safety in pregnancy and lactation, the application of these recommendations into clinical practice appears to be complex. Hence, we present some clinical questions with answers considering the available literature on safety of psychotropics in pregnancy and lactation.
    Full-text · Article · Feb 2009 · Indian Journal of Psychiatry
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