Abortion: A Psychiatric Patient's Right to Choose

Reproductive Decision-Making Capacity in Women With Psychiatric Illness: A Systematic Review

BACKGROUND

Decision-making capacity can be affected by psychiatric illness. Women who have psychiatric illness who make decisions about their reproductive health may require evaluation of their decision-making capacity.

OBJECTIVE

This article aims to characterize existing literature about capacity evaluations in women with psychiatric illness making reproductive decisions.

METHODS

We conducted a systematic review searching PubMed, EMBASE, Ovid PsycINFO, and ClinicalTrials.gov databases through July 2020. Articles were evaluated for relevance to inclusion criteria, first by title and abstract screening then by reading the full text of articles. Our inclusion criteria were case reports and studies that involved women of childbearing age with psychiatric illness making obstetrical decisions for whom decision-making capacity was evaluated. We qualitatively analyzed our data by examining themes within the studies, such as the circumstances of the referral and characteristics of reproductive decision-making. We also collected information about the clinical circumstances, such as the clinical setting (e.g., inpatient or outpatient, in primarily psychiatric or obstetric care) and who made the determination of capacity.

RESULTS

We identified 18 articles, which included 22 distinct patient cases and 27 distinct obstetrical decisions. Decisions about termination of pregnancy were most common, which were 10 of 27 decisions. Decisions about timing and mode of delivery accounted for 7 and 5 decisions, respectively. The most common psychiatric diagnosis reported was schizophrenia, which was present in 8 patients. Major depression and bipolar disorder were also frequently reported, present in 3 and 5 patients, respectively.

CONCLUSION

Patients who make health care decisions must have decision-making capacity. A patient with psychiatric illness does not inherently lack capacity, and in fact, most patients with psychiatric illness have decision-making capacity. Psychiatric illness, however, can add complexity to obstetrical medical decision-making. Reasons for this complexity include the involvement of many stakeholders, the often time-sensitive nature of these decisions, and the potentially unpredictable course of psychiatric illness. Successful management of these cases involves multidisciplinary collaboration, the use of preventative ethics through advanced care planning, and identification of a guardian or surrogate decision-maker when a patient is determined to lack decision-making capacity or for a patient who has capacity through advanced care planning.

PROSPERO REGISTRATION NUMBER

CRD42020143434.

Prevention inherent in services for women with schizophrenia

OBJECTIVE

Effective care to women with serious mental illness provides an opportunity for prevention of mental health problems in their offspring. The objective of this study is to outline the preventive possibilities of a service targeted to women with schizophrenia.

METHOD

An analysis of recently published literature on women suffering from schizophrenia, focusing on intervention.

RESULTS

Genetic counselling, prenatal care, prevention of obstetrical complications, substance abuse reduction, appropriate antipsychotic treatment, parenting support, safety issues, quality of life, ethics, cultural competence, and advocacy are components of a comprehensive service to women with schizophrenia.

CONCLUSIONS

These components improve maternal health and, by also ensuring fetal and neonatal health, are potentially preventive against schizophrenia in the second generation.