Schizophrenia occurs with equal frequency in men and women. But the treatment of the latter can be difficult due to a number of factors. Firstly, they show signs of psychopathology later, so it is difficult to notice it at an early stage. Secondly, a woman can become pregnant, which will complicate therapy. However, this does not mean that schizophrenia and pregnancy are incompatible. We will learn how modern medicine solves such problems.
Schizophrenia is a polymorphic endogenous disease of a chronic type, in which emotional reactions and thinking are affected. It can manifest itself in different ways depending on the form and variety, of which there are more than a dozen. Its exact causes are unknown to science, but most scientists talk about a genetic predisposition.
Schizophrenia is detected in approximately 1% of people, regardless of gender, age, nationality, and territory of residence. The risk of developing it increases if someone in the family or clan suffered from this or other mental disorders. According to statistics, the probability of a person developing a schizophrenic disease is about 20% if the mom or dad has the same psychopathology.
Most often, schizophrenia manifests itself at the age of 25-35 years, mostly in men a little earlier, and in women a little later.
These figures show that genetics if it causes the disease, is not 100%. There may be other factors that can provoke it. And some of them may be open in the future. Today, researchers have not yet uncovered the mechanism of occurrence and development of schizophrenia spectrum diseases.
Since there are many forms and types of schizophrenia, its symptoms are extensive. All symptoms are divided into two types:
- Negative, arising against the background of the passivity of the psyche and manifesting itself in the form of apathy, abulia, and other signs of a depressive type.
- Positive, indicating the activity of the mental apparatus and leading to the development of delirium, hallucinations or catatonic disorders.
The period when there are active signs is called an attack or exacerbation. Negative symptoms are characteristic of remission, a schizophrenic defect after a positive phase, or the onset of another psychosis.
Features of the course in women
Schizophrenia develops equally in men and women, but there are still specific features. Firstly, in the fair sex, the manifestation of the disease occurs a little later – after 4-6 years. Its symptoms are less pronounced, so most of the patient’s symptoms are not noticed or explained by stress, fatigue, lack of sleep, and other reasons.
Otherwise, the manifestations of the disease in men and women are similar: the signs, if we talk about terminology, are the same, but their content is different. For example, the stronger sex often suffers from delusions of jealousy, and delusional ideas associated with a threat to a child mainly appear in girls. But the symptom itself – delirium – happens to both.
Oddities in the behavior of a woman can be detected by trifles. Suppose she has become very clean and is terribly afraid of getting infected, which was previously observed for her. She takes a shower 2-3 times a day, washes the floors every evening, washes her hands several times before going out, washes the dishes before eating, etc.
She explains all this with the presence of bacteria and concern for the health of her family. Gradually, there are so many fears that the woman can no longer eat normally because the plates seem dirty to her. This can lead to real tantrums. Due to misunderstanding of loved ones, conflict and stress intensify.
Hallucinations, like delusions, are also often “feminine” in women. They are associated with the fear of getting sick, sometimes with the betrayal of her husband. Some women hear voices urging them to wash floors or make pointless purchases. Others feel insects under their skin, others believe that everyone is laughing at them, etc.
In other words, the nature of schizophrenia in women, if it differs, is precisely in such nuances. However, this is true if the woman is not pregnant. If she is also carrying a fetus or plans to become pregnant, then the problem becomes more complicated.
The question may arise whether, in principle, it is necessary to become pregnant or plan a pregnancy with such a severe diagnosis as schizophrenia. However, this pathology, although complex, does not exclude a person from the life process.
Firstly, there are many forms of it, some of which, for example, sluggish or latent, do not have pronounced signs. A woman may not be aware of the presence of psychopathology when she plans to have a child.
Secondly, a schizophrenic patient is not always in an inadequate state when he has delusions and hallucinations. During the period of remission, with a favorable course of pathology, the patient leads a normal life. Only in severe cases is he given a disability. During the calm phase of the disease, pregnancy can be planned, but only in accordance with the recommendations of a specialist. We’ll talk about them later.
In the first 15 years after the onset of the disease, women have higher social and sexual activity than men.
Third, there are coincidences. So, in a state of attack, a woman can lead a promiscuous sex life without being aware of her actions. In such situations, the danger is not only unwanted conception but also sexually transmitted diseases.
In other words, schizophrenia and pregnancy do not contradict each other and are quite common in practice. But at the same time, any such case gives rise to three types of problems:
- Genetics. There is a risk that the child will also subsequently develop psychopathology. However, it should be understood that the probability does not exceed 20%. If you create favorable conditions for living and raising a baby, then the risks are significantly reduced. Stress, violence, despotism, or permissiveness can provoke schizophrenia. These factors are recommended to be eliminated regardless of whether there is a predisposition to mental illness or not.
- The problem of bearing a fetus. First, schizophrenia can worsen at any time. In this state, pregnancy is dangerous both for the woman herself and for her unborn baby. Secondly, in case of mental illness, psychotropic drugs are prescribed, which have many side effects. They can lead to abnormal development of the fetus.
- Rehabilitation and social adaptation. The third factor has to do with upbringing. This is a responsible business, and for its implementation you need good physical and mental health. With disability, that is, a very unfavorable course of pathology, a woman can be limited in her rights.
In any case, when planning a pregnancy, these issues are discussed with the doctor. A woman in labor should be prepared both for childbirth and for subsequent interaction with the child.
Even healthy women experience stress during pregnancy and after childbirth. A disorder such as postpartum depression is a fairly common diagnosis. Mentally ill people find it even more difficult. Let’s see how these problems are solved with the help of modern methods of treatment.
Pregnancy itself in schizophrenia may not affect the development of psychopathology. It is not a fact that a woman will have an attack if she finds out that she is expecting a baby. The problem lies elsewhere – in the abrupt withdrawal of drugs. It can provoke an exacerbation, regardless of whether there is a pregnancy or not.
You can plan conception only a year after the start of remission. In this case, you first need to visit a psychiatrist and undergo an examination. It is necessary to make sure that there are no signs of the active phase, which at the very beginning may not be very intense.
In addition, the doctor must develop a new treatment regimen and select the appropriate drugs. All changes in pharmacotherapy should be carried out during the progredient period in order to reduce the exposure of the chemicals to the embryo.
But in this context, there are two problems. First, it is not always clear which drug to prescribe to the patient. The fact is that not much research has been done on this topic. At the disposal of physicians, there is a rather meager base of information regarding the effects of certain antipsychotic drugs on the body of a pregnant woman and her fetus.
Secondly, a pregnant woman who previously did not take any psychotropic drugs at all may turn up at a psychotherapist’s appointment. It turns out that you have to take risks by prescribing this or that substance. There are recommendations in both cases, but they cannot be considered proven methods that would be 100% studied.
Some of the relatively safe ones are:
- Women should take a high dose of folic acid 3 months before conception. After the start of pregnancy, the reception continues for another 3 months. This is especially recommended for patients with obesity and folate deficiency.
- Medications are selected not only for the period of gestation but also for the duration of lactation, even if the woman in labor does not plan to breastfeed the baby. Plans for a pregnant woman can change, and changing the drug is quite dangerous.
- In the treatment of schizophrenia during pregnancy, monotherapy is preferred, as one drug at a high dose is safer than several different drugs at low doses.
Complete withdrawal of medications is also possible if there are no symptoms of schizophrenia, and the patient feels well. But even in such situations, a sharp rejection of drug therapy can provoke another attack.
According to statistics, women with schizophrenia are twice as likely to experience preeclampsia, a complication of pregnancy. There is also a risk of premature birth, the development of anomalies in the child, and other complications. With such a diagnosis, women in labor require much more resources than healthy people. It is possible that hospitalization or the need for operative childbirth will be required. In addition, placental abruption and septic shock are often observed. In some cases, a caesarean section is necessary. Much depends on the condition of the patient – is she in remission or in the active phase. In the absence of positive symptoms, the likelihood of complications is much lower.
The risk of a woman dying a year after giving birth is 5 times higher if she has schizophrenia. Mortality is usually due to physiological rather than mental problems.
Schizophrenia is a very unpredictable disease. No doctor can give 100% guarantees that the attack will not recur, even if the patient follows all his recommendations. During pregnancy, it is even more difficult to make predictions.
Childbirth is stressful for a woman, even if the child is long-awaited. With schizophrenia, it is even more acute than for healthy women in labor. For this reason, the treatment of psychopathology does not stop not only during pregnancy but also after delivery. And we are talking about both drug therapy and psychotherapeutic sessions.
The further fate of the family depends on the condition of the patient. If schizophrenia does not become complicated and does not progress, there is a stable remission, and the patient does everything to prolong it, then the risks are reduced. In principle, with such a diagnosis, it is possible to provide a child with a full-fledged upbringing.
However, in some cases, the fate of the baby has to be decided by the court, for example, in situations where the spouses get divorced, and the father wants to take the children for himself, not wanting to leave them with a schizophrenic mother. But here it is important to remember that schizophrenia does not always prevent a woman from winning a lawsuit and taking the child for herself.
Let us formulate the basic principles that physicians adhere to when managing patients with schizophrenia during pregnancy:
- Do not abruptly stop taking medications or significantly reduce the dosage.
- If possible, drugs should be avoided during the first trimester of pregnancy.
- It is necessary to obtain consent for drug treatment not only from the woman but also from her spouse (or guardian, if the patient is disabled).
- It is better to give preference to proven tablets and injections that have already been used in the treatment of this patient.
- If necessary, hospitalization of the patient is indicated to restore her mental state.
- The use of complex drugs is undesirable, it is better to give preference to monotherapy.
- Control over the woman and the fetus should be carried out at all stages – from pregnancy planning to the end of the lactation period.
Relatives of a patient with schizophrenia should create favorable conditions for her life. Scandals, drinking alcohol and other factors can trigger an attack of the disease and related complications.
In general, a person diagnosed with schizophrenia, if he is in remission, has the right to a full life. He can work, play sports, start a family and have children. However, only those patients who are engaged in prevention and follow all the instructions of the psychotherapist can provide themselves with such an opportunity. First of all, the outcome of the disease depends on this, regardless of the presence or absence of pregnancy.