Indication for Psychiatric Inpatient Hospitalization for Pregnant Psychotic Women

The purpose of this article is to describe the challenges and opportunities for acute psychiatric inpatient staff to engage the psychotic pregnant woman in optimal psychiatric and obstetric care, in order to facilitate a positive outcome for mother and baby. We will describe the role of comprehensive, integrated services for mentally ill pregnant women, initiated on a specialized Inpatient Women's Issues Consultation Team and delivered in a culturally competent fashion. Illustrations will be taken from a composite case representing several common key clinical situations in our population. The myth that a medication-free pregnancy is always safest for the pregnant woman is dispelled, and thoughtful, individualized, and informed risk-benefit analysis is recommended instead. Risks for psychotic relapse are identified, appreciating that multiple stressors combine to create the need for comprehensive assessment and treatment in inpatient psychiatric units. Close collaboration among psychiatric, obstetric and pediatric inpatient-outpatient services promotes optimal execution of joint treatment planning. Rapidly restoring the woman to competency and engaging her in psychiatric and obstetric decision-making is the goal. In sum, specialized comprehensive services for psychotic pregnant women provide the opportunity for individualized, therapeutic, evidence-based care, addressing the complex mixture of socio-cultural, medical, obstetric and psychiatric issues each woman bears.