Schizophrenia « PATH

Schizophrenia is characterised by distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of time.

Psychopathological features of schizophrenia include thought echo, thought insertion or withdrawal, thought broadcasting, delusional perception and delusions of control, influence or passivity, hallucinatory voices commenting or discussing the patient in the third person, thought disorders and negative symptoms.¹

The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be one or more episodes with complete or incomplete remission.

Symptoms of schizophrenia include:

a lack of interest in things
feeling disconnected
difficulty concentrating
avoidance
hallucinations, such as hearing voices or seeing things others don’t
delusions (strong beliefs that others don’t share), including paranoid delusions
disorganised thinking and speech

Women with severe mental illness (which includes Schizophrenia) who give birth, have about a 30% risk of relapse in the first three months postpartum. A study has found that the risk is significantly increased in women with a relapse during pregnancy or with two or more relapses in the two years before pregnancy.²

In planning care for women with schizophrenia, health professionals involved should take into account the complexity of the condition and the challenges of living with severe mental illness. Where available, involve specialist perinatal mental health services.

The woman’s ability to parent may be affected by cognitive and negative symptoms, thus needing additional support with parenting and referral to social services, if warranted. If the woman harbours delusions involving the foetus or infant, a thorough risk assessment, safeguarding considerations and urgent referral to specialist services is necessary.

Antenatal care:

Monitor for early signs of relapse, particularly if medications are discontinued
Engage women and their families on psychoeducation on relapse indicators, early warning signs of relapse, lifestyle changes that can prevent relapse and maintain wellbeing
Monitor for weight gain and gestational diabetes due to use of psychotropics
Refer women to specialist perinatal service
Consider adult and children’s safeguarding issues.

Postnatal care:

Support the woman to bond with their baby, if bonding has been compromised
Practical help and support may be necessary to ensure wellbeing of mother and care of baby
Careful monitoring by midwife, health visitor, perinatal team for signs of relapse
If relapse occurs, admission to a mother and baby unit may be warranted

Psychosocial and psychological therapies:

Psychoeducation and supportive therapy that includes partner/close family members
Psychological therapies may be offered as per the need

Pharmacological treatments:

Discussions about treatment options during preconception period/pregnancy is vital to avoid relapse.
This may require involvement of a specialist perinatal psychiatrist.

Resources

RCPysch patient information leaflet on Schizophrenia

Training for healthcare professionals:

Watch our videos showing an example GP appointment with a patient who has experienced previous psychosis.

References

1. World Health Organization (WHO). The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization, 1993.

2. Clare L. Taylor, Robert J. Stewart, Louise M. Howard, Relapse in the first three months postpartum in women with history of serious mental illness, Schizophrenia Research, 2019.