Schizophrenia occurs with an equal frequency in men and women. But the treatment can be complicated by various factors. First, symptoms of psychopathology appear later in them, so it isn’t easy to notice it at an early stage. Secondly, a woman can become pregnant. However, this does not mean that schizophrenia and pregnancy are incompatible. Let’s find out how modern medicine solves such problems.
Schizophrenia is a polymorphic chronic endogenous disease 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 dozens. Its exact causes are unknown, but most scientists point to a genetic predisposition.
Schizophrenia is diagnosed in about 1% of people, regardless of gender, age, nationality, and territory of residence. The risk of its development increases if someone in the family or ancestors suffers from this or other mental disorders. According to statistics, a person has about a 20% chance of developing schizophrenic illness if their mother or father has the same psychopathology.
Schizophrenia manifests itself at 25-35, mostly in men a little earlier and in women a little later.
These figures show that even if genetics is responsible for the disease, it’s not 100%. There may be other factors that can provoke it. Discover some of these factors in the future. Researchers haven’t yet discovered the mechanism of schizophrenic spectrum disorders and their development.
Since schizophrenia has many forms and types, its symptomatology is extensive. All symptoms are divided into two types:
- Negative, arising from the passivity of the psyche and manifested in the form of apathy, abulia, and other signs of the 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, schizophrenic defect after a positive phase, or the beginning of another psychosis.
Features of the progression in women
Schizophrenia develops equally in men and women, but specific features remain. Firstly, the disease manifestation in the fair sex occurs a little later – after 4-6 years. Its symptoms are less expressed, so most of the symptoms are not noticed by the patients or explained by stress, fatigue, lack of sleep, and other causes.
Otherwise, the disease manifestations in men and women are similar: the signs, if we talk about terminology, are the same, but their content is different. For example, delusions of jealousy more often affect the stronger sex, and delusions related to threats to the child mostly appear in girls. But the symptom itself – delirium – occurs in both.
Little things can detect strange behavior in women. For example, she became very clean and panicked, afraid of getting infected, which was previously observed. She takes 2-3 showers a day, washes the floor every evening, washes her hands several times before going out, washes the dishes before eating, etc.
She attributes all this to bacteria and concern for her family’s health. Gradually there is so much fear that the woman can no longer eat because she thinks the plates are dirty. It can lead to real tantrums because of the increased misunderstanding of loved ones, conflict, and stress.
Hallucinations, as well as delusions, in women are also often “feminine. They are connected with the fear of illness and sometimes the husband’s infidelity. Some women hear voices urging them to scrub the floors or make pointless purchases. Others feel insects under their skin, and others feel that everyone is laughing at them, etc.
In other words, the nature of schizophrenia in women, if anything, differs in just such nuances. However, this is true if the woman is not pregnant. If she is also carrying a fetus or is planning to become pregnant, the problem becomes more complicated.
The question may arise as to whether, in principle, it is necessary to get pregnant or to plan a pregnancy with such a severe diagnosis as schizophrenia. However, this complex pathology does not exclude a person from the process of life.
First, there are many types of schizophrenia, some of which, sluggish or latent, have no apparent signs. A woman may not suspect she has psychopathology when planning to have a baby.
Second, the schizophrenic patient is not always in an inadequate state when he has delusions and hallucinations. The patient leads a normal life during remission with a good pathology course. Only in severe cases is he assigned a disability. During the quiet phase of the disease, pregnancy can be planned, but only by the recommendations of a specialist. We will talk about them later.
In the first 15 years after the disease’s debut, women are more socially and sexually active than men.
Thirdly, there are also accidents. Thus, in a state of attack, a woman can have an indiscriminate sexual life, not realizing the accountability of their actions. In such situations, the danger is the unwanted conception and venereal diseases.
In other words, schizophrenia and pregnancy do not contradict each other and, in practice, occur quite often. But any such case generates three kinds of problems:
- Genetics. There is a risk that the child will also develop psychopathology later on. However, it is necessary to understand that the probability does not exceed 20%. The risks are greatly reduced if favorable living conditions and the baby’s upbringing are created. Stress, violence, despotism, or permissiveness can provoke schizophrenia. These factors are recommended to eliminate regardless of whether there is a predisposition to mental illness.
- The problem of carrying a fetus. First, at any time, schizophrenia can become complicated. Pregnancy is dangerous for the woman and her future baby in such a condition. Secondly, psychotropic medications are prescribed for mental illnesses, which have many side effects. They can lead to abnormal development of the fetus.
- Rehabilitation and social adaptation. The third factor is related to education. It is a matter of responsibility and requires good physical and mental health. Has a disability, i.e., a very unfavorable pathology; a woman may be limited in her rights.
When planning a pregnancy, these issues are discussed with the doctor. The expectant mother must be prepared for childbirth and subsequent interaction with the child.
Stress is experienced even by healthy women during pregnancy and after delivery. Such a disorder as postpartum depression is a fairly common diagnosis. Mentally ill people have an even more difficult time. Let’s see how these problems are solved with the help of modern methods of treatment.
The pregnancy itself in schizophrenia may not affect the development of psychopathology. It is not a fact that a woman will have a seizure if she finds out she is expecting a baby. The problem lies elsewhere – in the abrupt withdrawal of medications. It can provoke an exacerbation, regardless of whether there is a pregnancy.
It is possible to plan to conceive only after a year after the beginning of remission. In this case, you must first visit a psychiatrist and undergo an examination. Make sure there are no signs of an active phase, which may not be very intense initially.
In addition, the doctor should develop a new treatment regimen and select the appropriate medications. All changes in pharmacotherapy should be done in the progredient period to reduce the impact of chemicals on the embryo.
But there are two problems in this context. 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. Doctors have at their disposal a rather scanty database of information regarding the effects of certain antipsychotic medications on the body of a pregnant woman and her fetus.
See Also: Remission in schizophrenia.
Secondly, a pregnant woman who has not previously taken psychotropic medications may be seen at the psychotherapist’s office. It means that it will have to take a risk by prescribing a particular substance. Recommendations are available in both cases, but consider them proven methods that have been studied 100% can not.
Some of the relatively safe ones are:
- Women should take folic acid at a high dose three months before conception. After pregnancy begins, the intake continues for another three months. It is especially recommended for patients with obesity and folate deficiency.
- Medications are chosen not only for the period of pregnancy but also during lactation, even if the woman has no plans to breastfeed. A pregnant woman’s plans may change, which is dangerous enough to change the medication.
- Monotherapy is preferred when treating schizophrenia during pregnancy because one drug in a high dose is safer than several drugs in low doses.
Complete medication withdrawal is also possible if there are no symptoms of schizophrenia and the patient feels well. But even in such situations, abrupt withdrawal of drug therapy may provoke another attack.
Statistically, women with schizophrenia are twice as likely to experience a variety of pregnancy complications and pre-eclampsia. There is also a risk of premature birth, the development of abnormalities in the child, and other complications. With this diagnosis, laboring women need much more resources than healthy people. Hospitalization or the need for a surgical delivery may be necessary.
In addition, placenta detachment and septic shock are not uncommon. In some cases, a cesarean section has to be done. Much depends on the patient’s condition – whether she is in remission or the active phase. The probability of complications is much lower in the absence of positive symptoms.
A woman’s death risk a year after delivery is five times higher if there is schizophrenia. Deaths are usually due to physiological, not mental, problems.
Schizophrenia is a very unpredictable illness. No doctor will give a 100 percent guarantee that a seizure will not recur, even if the patient follows all his recommendations. It is even harder to make predictions during pregnancy.
Childbirth is stressful for a woman, even if the baby 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 psychotherapy sessions.
The fate of the family depends on the condition of the patient. If schizophrenia is not complicated and does not progress, a stable remission is observed, and the patient does everything to prolong it, then the risks are reduced. Providing a child with a full-fledged upbringing with such a diagnosis is possible.
However, in several cases, the child’s fate must be decided in court, for example, in situations where spouses divorce and the father wants to take the children, not wanting to leave them with a schizophrenic mother. But even here, it is important to remember that schizophrenia does not always prevent a woman from winning a court case and taking the child.
Let us outline the basic principles that medical professionals adhere to when managing patients with schizophrenia during pregnancy:
- Medications should not be abruptly interrupted or should significantly reduced the dosage.
- If possible, should avoid medications for the first trimester of pregnancy.
- It is necessary to obtain consent for medication treatment not only from the woman but also from her spouse (or guardian if the patient is disabled).
- It is better to prefer proven pills and injections already used in this patient’s therapy.
- If necessary, hospitalization of the patient to restore her mental state is indicated.
- The use of complex medications is undesirable. It is better to give preference to monotherapy.
- Control of the woman and fetus should be carried out at all stages – from the planning of pregnancy to the end of the lactation period.
Relatives of a patient with schizophrenia should create favorable conditions for her life. Scandals, drinking alcoholic beverages, and other factors can provoke an attack on the disease and its complications.
If he is in remission, a person with a schizophrenic diagnosis has the right to a full life. He can work, play sports, have a family, and have children. However, only those patients who are engaged in prevention and follow all of the psychotherapist’s prescriptions can provide this opportunity. Above all, it depends on the disease’s outcome, regardless of the presence or absence of pregnancy.