Broadly speaking, pregnancy appears to protect against psychiatric disorder, an effect having probable survival value in evolutionary terms. First onset of psychiatric disorder during pregnancy is rare, existing disorders tend to become less severe, and suicide rates during pregnancy and the puerperium are low. However, women with a history of chronic or recurrent psychiatric disorder require continuing assessment and care during pregnancy, and monitoring to detect and treat any worsening after childbirth, with the health and safety of both mother and baby in mind.

Psychotropic drug treatment during pregnancy, although best avoided for the baby's sake, is sometimes essential for the mother's mental health. There is no evidence that antipsychotics, tricyclic antidepressants, or benzodiazepines cause serious harm to the foetus, although a newborn whose mother had been taking benzodiazepine might exhibit a transient withdrawal syndrome. The key point is that organogenesis is largely complete by 3 months; hence, it is most unlikely that medication taken from then on could cause malformation, the adverse effect most feared by parents and prescribers.

Hence, the undoubted desirability of the mother's being drug free throughout pregnancy sometimes has to be set aside. It then becomes a matter of balancing a potential risk to the baby from intrauterine exposure to psychotropic medication against the mental health needs of the mother. Frequently, the baby's need to have a well mother after birth tips the balance toward cautious use of medication during pregnancy if other treatment measures have proved insufficient.

However, lithium should be avoided, because it may cause foetal thyroid enlargement and, if taken in the first trimester, foetal cardiac malformation. It is important that the mother receives full information about proposed drug therapy, and gives informed consent (see British National Formulary guidelines on prescribing in pregnancy).

ECT can safely be given in pregnancy.

Unplanned pregnancies sometimes occur in women whose judgement is affected by psychiatric illness or learning disability, and may remain undiagnosed until a late stage.

Hyperemesis gravidarum refers to unusually prolonged and severe forms of the normal experience of vomiting ('morning sickness') during the early stages of pregnancy. While there may be physical causes, such as multiple pregnancy, psychosocial aspects - especially anxiety - are often prominent.

Pseudocyesis is 'phantom pregnancy'; that is, the woman develops symptoms and even signs of pregnancy, including abdominal distension, in the absence of a pregnancy. It is, however, now rare in UK practice. Couvade refers to an anala-gous syndrome in the man, who develops these features, as it were, in sympathy with the mother. Again, it is rare.

Conquering Fear In The 21th Century

Conquering Fear In The 21th Century

The Ultimate Guide To Overcoming Fear And Getting Breakthroughs. Fear is without doubt among the strongest and most influential emotional responses we have, and it may act as both a protective and destructive force depending upon the situation.

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