Toward a family planning program in psychiatric hospitals

Psychiatric admission during pregnancy in women with schizophrenia who attended a specialist antenatal clinic

Objectives: The mental health and wellbeing of pregnant women with schizophrenia is an area of research interest. We aim to explore this relationship particularly in regards to psychiatric admission rates, timing and their associated contributing factors. Methods: A total of 98 pregnancies to women with schizophrenia, who attended a specialist antenatal clinic and delivered from July 2007 to February 2016, were retrospectively examined. The cohort was divided into two groups based on psychiatric admission. Descriptive data were analyzed using SPSS software. Results: Overall, 40.8% required psychiatric admission during pregnancy. A higher proportion of subjects had their initial psychiatric admission in the first trimester compared to the third trimester (p = .002). Of note, 10.2% were admitted within one month either side of conception. Women with admission also presented later for their first antenatal appointment (p = .04, 95% CI -2.1 to -1.9). Psychiatric admission was associated with substance (p = .014) and alcohol use (p = .001), child protective services involvement (p = .022) and infant being placed in out-of-home care (p = .01), but not with poorer obstetric or neonatal outcomes. Conclusion: High rates of psychiatric admission are evident throughout pregnancy for women with schizophrenia, with a high proportion of first presentations for admission occurring in the first trimester. Psychiatric admission is associated with poorer antenatal care attendance and adverse psychosocial outcomes, highlighting the need for enhanced multidisciplinary pregnancy care for this at risk group. Inpatient psychiatric services should consider pregnancy testing and contraception review for all women of childbearing age, admitted with schizophrenia.

Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders

OBJECTIVE

Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs.

METHOD

The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology.

RESULTS

The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs.

CONCLUSIONS

These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.

The fertility and fecundity of patients with psychoses

OBJECTIVE

Previous research has suggested that patients with schizophrenia have fewer offspring compared to the general population. Reduced fertility in a disorder with a strong genetic component and an apparently stable incidence has implications for models of genetic transmission. There is also a need to obtain contemporary estimates of the prevalence of parenthood among subjects with psychotic disorders in order to inform service planning. The aim of this study was to determine the fertility and fecundity of a representative sample of individuals with psychoses who were in contact with mental health services, and to explore the interactions between age at first diagnosis and fertility.

METHOD

All clients of two community mental health clinics and an extended-care psychiatric hospital were surveyed. Data on diagnosis, age at first diagnosis, and the number and age of offspring were collected. Based on interviews with the proband and chart review, a genogram of the probands' family was drawn that identified sex, age, affected status and the number of offspring for each patient and their siblings.

RESULTS

In total, 36% of all patients were parents. Most women with psychoses (59%) were mothers. Patients with psychoses had fewer offspring compared to their unaffected same-sex siblings. This was especially the case for men with non-affective psychoses. Higher levels of fertility were associated with a later age at first diagnosis.

CONCLUSION

The consistent finding of reduced 'reproductive fitness' in those with non-affective psychoses needs to be incorporated in the genetic epidemiology of these disorders. Despite this reduction in fertility and fecundity, many patients with psychoses are parents. Services need to remain mindful of the special needs of these patients.

Staff attitudes towar a family planning service in the mental hospital

Staff attitudes toward an innovative family planning and gynecological service offered to patients in three psychiatric hospitals were assayed. Despite structural differences between hospitals, generally similar and favorable reports were obtained at all sites. However, comparison of verbal responses and actual utilization of the family planning service suggests that a theoretical position held by a minority as well as scattered personal biases militate against fullest cooperation with the program.