Keywords
Perinatal Care
Pregnant Woman
Postpartum Period
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To identify therapeutic approaches for managing psychosis in women during pregnancy and the postpartum period. Methods: Integrative review of the literature in the SciELO, MedLine (via PubMed) and LILACS databases. Articles from the last five years were included, which presented clinical approaches to the topic. Studies that did not specifically include women during perinatal period were excluded. The search was carried out using the descriptors "Psychotic Disorders", "Perinatal Care", "Pregnant Women" and "Postpartum Period". Results: Seven articles on the management of psychosis during the perinatal period were included in the study. The evidence demonstrates the importance of screening for psychosis during the perinatal period, emphasizing a multidisciplinary approach. Lithium is indicated as the main form of treatment, with ECT for severe cases. During pregnancy, serum monitoring is crucial. Hospitalization in conventional wards is questioned, with patient-centered management and support for families being prioritized. Final considerations: The urgency of integrated, empathetic and preventive approaches, to ensure psychological well-being during pregnancy and the postpartum period, is highlighted. The scarcity of information emphasizes the crucial need for research to improve intervention strategies and adequate support for women during this delicate period.
References
AMERICAN PSYCHIATRIC ASSOCIATION. Diagnostic and Statistical Manual of Mental Disorders. 5 ed. Porto Alegre: Artmed, 2014.
BRASIL. Lei Nº 14.721, de 8 de novembro de 2023. Altera os arts. 8º e 10º da Lei nº 8.069, de 13 de julho de 1990 (Estatuto da Criança e do Adolescente), para ampliar a assistência à gestante e à mãe no período da gravidez, do pré-natal e do puerpério. Brasília, DF: Diário Oficial da União, 2023.
FORDE R, et al. Psychological interventions for managing postpartum psychosis: A qualitative analysis of women’s and family members’ experiences and preferences. BMC Psychiatry, 2019; 19(1): 411.
FORDE R, et al. Recovery from postpartum psychosis: a systematic review and metasynthesis of women’s and families’ experiences. Archives of Women's Mental Health, 2020; 23: 597-612.
FORNARO M, et al. Lithium exposure during pregnancy and the postpartum period: A systematic review and meta-analysis of safety and efficacy outcomes. The American journal of psychiatry, 2020; 177(1): 76–92.
FRIEDMAN SH, et al. Postpartum psychosis. Current psychiatry reports, 2023; 25(2): 65–72.
GILDEN J, et al. Mother-to-infant bonding in women with postpartum psychosis and severe postpartum depression: a clinical cohort study. Journal of Clinical Medicine, 2020; 9(7): 2291.
GONZÁLEZ-RODRÍGUEZ A. e SEEMAN MV. The association between hormones and antipsychotic use: a focus on postpartum and menopausal women. Therapeutic advances in psychopharmacology, 2019; 9: 2045125319859973.
GROVER S, et al. ECT in the postpartum period: a retrospective case series from a tertiary health care center in India, 2018; 40(6): 562-567.
HAUGE C, et al. Treatment of postpartum psychotic‐ or mood disorder requiring admission: A nationwide study from Denmark. Acta psychiatrica Scandinavica, 2023; 147: 1–9.
HENRIQUES-CALADO J, et al. Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study. Borderline personality disorder and emotion dysregulation, 2023; 10(1).
MAYERS A, et al. Supporting women who develop poor postnatal mental health: what support do fathers receive to support their partner and their own mental health? BMC Pregnancy and Childbirth, 2020, 20(1): 1-9.
MCCLEERY A e NUECHTERLEIN KH. Cognitive impairment in psychotic illness: prevalence, profile of impairment, developmental course, and treatment considerations. Dialogues in clinical neuroscience, 2019; 21(3): 239–248.
ORTEGA MA, et al. A review: Integrative perspectives on the features and clinical management of psychotic episodes in pregnancy. Journal of clinical medicine, 2023; 12(2): 656.
OSBORNE LM. Recognizing and managing postpartum psychosis: A clinical guide for obstetric providers. Obstetrics and gynecology clinics of North America,2018; 45(3): 455-468.
PERRY A, et al. Phenomenology, epidemiology and aetiology of postpartum psychosis: A review. Brain sciences,2021; 11(1): 47.
RODRIGUEZ-CABEZAS L. e CLARK C. Psychiatric emergencies in pregnancy and postpartum. Clinical obstetrics and gynecology, 2018; 61(3): 615–627.
RÖNNQVIST I. et al. Rehospitalization of postpartum depression and psychosis after Electroconvulsive therapy: A population-based study with a matched control group. The journal of ECT, 2019; 35(4): 264-271.
ROXBURGH E, et al. Experiences of mental health care among women treated for postpartum psychosis in England: A qualitative study. Community mental health journal, 2023; 59(2): 243–252.
RUNDGREN S, et al. Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group. Journal of affective disorders, 2018; 235: 258-264.
SCHORETSANITIS G, et al. Blood levels to optimize antipsychotic treatment in clinical practice: A joint consensus statement of the American society of clinical psychopharmacology and the therapeutic drug monitoring task force of the Arbeitsgemeinschaft für neuropsychopharmakologie und pharmakopsychiatrie. The journal of clinical psychiatry, 2020;81(3).
YADAWAD V, et al. Short-term outcome of mothers with severe mental illness admitted to a mother baby unit. Indian J Psychiatry, 2021; 63(3): 245-249.