my presentation about psychotropics in pregnant and lactating woman, my target is to help to know how mental illness affect mother and baby and how drugs affect mother and baby and when we start medications and how
This document discusses psychotropic medication use during pregnancy. It provides the following guidelines:
1. Old and safe psychotropics should be used, and antidepressants like SSRIs are generally considered safe during pregnancy, while paroxetine poses risks.
2. Anticonvulsants and benzodiazepines should be used cautiously as they may cause birth defects.
3. For certain disorders like bipolar disorder, continuing treatment during pregnancy may pose less risk than relapse, though lithium should be avoided in the first trimester.
4. Treatment decisions require weighing risks and benefits for both mother and baby's health, and should be made by the patient and her medical team. Low
Antipsychotics and mood stabilizers in pregnancyMohamed Sedky
Objectives:
Background risk of spontaneous congenital anomalies
The impact of mental illness on pregnancy
The impact of pregnancy on mental illness
The impact Antipsychotics and mood stabilizers on pregnancy outcome
Recommendations for prescribing during pregnancy
What to include in discussions with a pregnant women
This document provides information on FDA pregnancy drug labeling categories and discusses various antidepressant and other psychotropic medications. It describes the FDA categories A through X for evaluating risks of medications during pregnancy and lists common antidepressants along with their FDA categories. For each medication class, it summarizes potential risks to the fetus or newborn based on available studies. The document emphasizes making individualized treatment decisions and monitoring for potential neonatal side effects.
This document summarizes various neuropsychiatric sequelae that can occur after a stroke. It discusses conditions like post-stroke depression (occurring in 30-40% of patients), anxiety disorders (25%), apathy (20%), pathological laughing/crying (11-35%), catastrophic reactions (20%), and more rare conditions like mania, bipolar disorder, and psychosis. It provides details on risk factors, pathophysiology, diagnosis, and treatment approaches for these different post-stroke neuropsychiatric conditions.
This document discusses treatment resistant depression. It begins by providing epidemiological data on depression worldwide and notes that treatment resistant depression (TRD) is becoming more prevalent. It then discusses factors associated with TRD like psychiatric and medical comorbidities, gender, family history, illness severity and chronicity. The document outlines approaches to defining and staging TRD. It discusses challenges in differentiating true treatment resistance from pseudo-resistance. Finally, it summarizes large clinical trials on sequencing treatments for TRD like the STAR*D trial.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
This document discusses treatment options for treatment-resistant depression (TRD). It defines TRD as major depression that does not resolve with adequate antidepressant treatment. Approximately 15-20% of depressed patients will have TRD. Treatment options discussed include optimization or augmentation of antidepressants, switching antidepressants, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. Future treatment options discussed are novel agents like S-adenosylmethionine and devices like deep brain stimulation. TRD poses substantial economic and disability burdens.
This document discusses treatment resistant schizophrenia, including definitions of response, remission, and resistance. It describes assessments that should be conducted before labeling a patient's schizophrenia as drug resistant, including evaluating for pseudo-resistance, co-occurring conditions, organic causes, antipsychotic side effects, and medication nonadherence. Management strategies discussed include optimizing antipsychotic drugs and doses, considering clozapine as the gold standard, and various augmentation strategies if clozapine fails such as with other antipsychotics, mood stabilizers, antidepressants, or other agents targeting glutamatergic transmission.
This document discusses psychotropic medication use during pregnancy. It provides the following guidelines:
1. Old and safe psychotropics should be used, and antidepressants like SSRIs are generally considered safe during pregnancy, while paroxetine poses risks.
2. Anticonvulsants and benzodiazepines should be used cautiously as they may cause birth defects.
3. For certain disorders like bipolar disorder, continuing treatment during pregnancy may pose less risk than relapse, though lithium should be avoided in the first trimester.
4. Treatment decisions require weighing risks and benefits for both mother and baby's health, and should be made by the patient and her medical team. Low
Antipsychotics and mood stabilizers in pregnancyMohamed Sedky
Objectives:
Background risk of spontaneous congenital anomalies
The impact of mental illness on pregnancy
The impact of pregnancy on mental illness
The impact Antipsychotics and mood stabilizers on pregnancy outcome
Recommendations for prescribing during pregnancy
What to include in discussions with a pregnant women
This document provides information on FDA pregnancy drug labeling categories and discusses various antidepressant and other psychotropic medications. It describes the FDA categories A through X for evaluating risks of medications during pregnancy and lists common antidepressants along with their FDA categories. For each medication class, it summarizes potential risks to the fetus or newborn based on available studies. The document emphasizes making individualized treatment decisions and monitoring for potential neonatal side effects.
This document summarizes various neuropsychiatric sequelae that can occur after a stroke. It discusses conditions like post-stroke depression (occurring in 30-40% of patients), anxiety disorders (25%), apathy (20%), pathological laughing/crying (11-35%), catastrophic reactions (20%), and more rare conditions like mania, bipolar disorder, and psychosis. It provides details on risk factors, pathophysiology, diagnosis, and treatment approaches for these different post-stroke neuropsychiatric conditions.
This document discusses treatment resistant depression. It begins by providing epidemiological data on depression worldwide and notes that treatment resistant depression (TRD) is becoming more prevalent. It then discusses factors associated with TRD like psychiatric and medical comorbidities, gender, family history, illness severity and chronicity. The document outlines approaches to defining and staging TRD. It discusses challenges in differentiating true treatment resistance from pseudo-resistance. Finally, it summarizes large clinical trials on sequencing treatments for TRD like the STAR*D trial.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
This document discusses treatment options for treatment-resistant depression (TRD). It defines TRD as major depression that does not resolve with adequate antidepressant treatment. Approximately 15-20% of depressed patients will have TRD. Treatment options discussed include optimization or augmentation of antidepressants, switching antidepressants, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. Future treatment options discussed are novel agents like S-adenosylmethionine and devices like deep brain stimulation. TRD poses substantial economic and disability burdens.
This document discusses treatment resistant schizophrenia, including definitions of response, remission, and resistance. It describes assessments that should be conducted before labeling a patient's schizophrenia as drug resistant, including evaluating for pseudo-resistance, co-occurring conditions, organic causes, antipsychotic side effects, and medication nonadherence. Management strategies discussed include optimizing antipsychotic drugs and doses, considering clozapine as the gold standard, and various augmentation strategies if clozapine fails such as with other antipsychotics, mood stabilizers, antidepressants, or other agents targeting glutamatergic transmission.
Akathisia is a neurological side effect of antipsychotic and antidepressant medications characterized by inner restlessness and a constant need for movement. It is caused by a loss of dopamine function in the brain. The prevalence of akathisia ranges from 12.5-75% when taking first-generation antipsychotics. While difficult to diagnose, it can often be treated with benzodiazepines, beta-blockers like propranolol, or reducing the dose of the causative medication. Left untreated, akathisia can lead to poor treatment adherence.
This document summarizes several newer antipsychotic medications introduced after 2005, including paliperidone, iloperidone, asenapine, lurasidone, blonanserin, and cariprazine. It describes the indication, mechanism of action, pharmacokinetics, adverse effects, dosing, and precautions for each drug. It also briefly discusses brexiprazole and several investigational antipsychotics targeting non-dopamine receptors with limited success to date, such as pomaglumetad, sarcosine, and pimaverine.
Akathisia is a sensorimotor movement disorder caused by drugs like antipsychotics that block dopamine pathways in the brain. It involves feelings of inner restlessness and a compelling need to be in constant motion. Differential diagnoses include anxiety, agitation, and other drug-induced movement disorders. Treatment focuses on reducing the causative medication, correcting underlying conditions, and using anticholinergic or serotonergic drugs to alleviate symptoms.
Anxiety disorders are the most prevalent psychiatric disorders. They are characterized by feelings of fear, apprehension and worry that interfere with daily functioning. Common types include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, social phobia and specific phobia. Symptoms are often somatic in nature and patients frequently seek treatment in primary care settings. Effective treatments include cognitive behavioral therapy and antidepressant medications.
This document discusses novel neurotransmitters beyond the classical ones. It describes nitric oxide, carbon monoxide, hydrogen sulfide, endocannabinoids, eicosanoids, and neurosteroids. Nitric oxide is produced in neurons from arginine and acts through cGMP. It is involved in long term potentiation and erectile function. Carbon monoxide regulates olfaction and vasodilation. Hydrogen sulfide is produced from cysteine and acts as a gaseous messenger. Endocannabinoids like anandamide signal retrogradely through CB1 receptors. Eicosanoids are derived from arachidonic acid. Neurosteroids are synthesized in the brain from cholesterol and include allopregn
This document provides information on various classes of antipsychotic and antidepressant medications. It discusses the mechanisms and uses of tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors for treating conditions like depression. It also covers typical and atypical antipsychotics used to treat schizophrenia and other psychoses, describing their dopamine receptor blocking effects. Mood stabilizing drugs like lithium are mentioned for managing manic-depressive disorder.
1) The document discusses the etiopathogenesis of schizophrenia, including genetics, epidemiology, and various theories of causation.
2) Key points include that schizophrenia has a genetic basis but is influenced by environmental factors, with family studies showing around a 10% risk for first-degree relatives.
3) Several candidate genes have been implicated in increasing risk, such as dystrobrevin-binding protein 1 and neuregulin 1, but results have been inconsistent. Other factors explored include infections, immunological mechanisms, and neuroanatomical and neurochemical abnormalities.
Neuropsychiatric manifestations of head injurySantanu Ghosh
This document summarizes a presentation on neuropsychiatric aspects of head injury. It begins with an introduction discussing the prevalence of head injuries. It then covers the history of understanding head injuries, comparative diagnostic classifications, epidemiology, types and pathophysiology of head injuries including acute and chronic behavioral consequences. The presentation also discusses clinical features such as cognitive impairment, personality changes, mood disorders, anxiety, aggression and psychosis. It concludes with discussing prognosis and predictors of outcome following head injury.
Neuropsychiatric aspects of traumatic brain injuryAzfer Ibrahim
1) Traumatic brain injury (TBI) can cause various neuropsychiatric issues including mood disorders, cognitive deficits, and behavioral changes.
2) Common mood disorders after TBI include depression in 25-50% of patients in the first year, as well as increased risks of mania/hypomania and anxiety disorders.
3) Frequent cognitive deficits involve problems with memory, attention, concentration, language, and executive functioning that can cause long-term impairment.
This document provides information on the pharmacology of second generation antipsychotics. It discusses the history and development of antipsychotic drugs from chlorpromazine to clozapine. It describes the mechanisms of action of atypical antipsychotics including their effects on serotonin and dopamine receptors. The document classifies antipsychotics and examines the pharmacology of individual drugs like clozapine, risperidone, and olanzapine, covering their indications, mechanisms, side effects and interactions.
The document discusses bipolar disorder, also known as manic-depressive disorder. It is characterized by periods of elevated mood and periods of depression. During manic episodes, symptoms may include distractibility, insomnia, grandiosity, flight of ideas, increased activity or psychomotor agitation, risky behavior, and talkativeness. The causes of bipolar disorder are thought to include genetic, physiological, environmental, neurological, and neuroendocrine factors. Treatment involves hospitalization during severe episodes, as well as mood stabilizers, antipsychotics, antidepressants, ECT, psychotherapy, lifestyle changes, and substance abuse treatment.
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
Mood stabilizers for (Bipolar disorder, Schizophrenia and Mania) Bhudev Global
This document provides information about mood stabilizers, their uses, mechanisms of action, and side effects. It discusses several individual drugs used as mood stabilizers including lithium, valproate, and carbamazepine. Lithium is described as the classic mood stabilizer that works by decreasing sodium content load and levels of neurotransmitters like norepinephrine and dopamine. Valproate and carbamazepine are also described as having GABAergic effects that contribute to their antimanic properties. Common and rare side effects are outlined for each drug along with details about drug interactions.
1. Psychosis is common in epilepsy patients, occurring in 1-35% of cases and being 8 times more prevalent than in the general population.
2. Psychosis in epilepsy is classified as ictal, inter-ictal, post-ictal, or antiepileptic drug induced.
3. Diagnosis requires distinguishing psychosis in epilepsy from schizophrenia based on symptoms and personality features, and treatment involves careful use of antiepileptic and antipsychotic drugs due to interactions.
Resistant depression is difficult to treat depression that does not respond adequately to multiple antidepressant treatments. It is defined as failure to respond to 2 adequate trials of antidepressants from different classes. Depression is a leading cause of disability worldwide and resistant depression has a poor prognosis with high relapse rates. Causes of resistance include medical comorbidities, substance abuse, personality disorders, chronicity of depression, and inadequate previous treatment. Management involves re-evaluating treatment adequacy and using strategies like optimizing dose and duration, augmentation, switching medications, somatic treatments, and non-pharmacological therapies. Long-term maintenance treatment for 6-9 months or more is often required to prevent relapse.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
Schizophrenia is linked to over a dozen genes that regulate neuronal connectivity, synaptogenesis, NMDA glutamate receptors, and neuronal migration. It is also regulated by four genes: BDNF, Dysbindin, DISC1, and neuregulin. Schizophrenia is postulated to have four stages: stage 1 from birth to 15 with full functioning; stage 2 from 15-20 with subtle symptoms; stage 3 from 20-40 with acute positive symptoms and relapses; and stage 4 from 40-60 with prominent negative and cognitive symptoms and continuing disability.
Schizophrenia is a chronic brain disorder that causes difficulties with thinking, emotions and behavior. Symptoms usually emerge in late teens to early 30s and include hallucinations, delusions, disorganized speech and behavior. Genetics and environmental factors both contribute to its development. Treatment involves antipsychotic medications to manage symptoms as well as support for independent living. Relapse is common if medications are stopped, so ongoing monitoring and compliance are important for long-term management of the condition.
This document provides an overview of adverse effects of antipsychotics. It begins with an introduction and outlines the presentation scheme. Neurological side effects are discussed first, including neuroleptic induced movement disorders such as acute syndromes like dystonia, pseudoparkinsonism, and akathisia as well as tardive syndromes. Non-neurological side effects affecting endocrine, sexual, metabolic, cardiovascular, hematological, gastrointestinal, hepatic, dermatological and ophthalmological systems are also reviewed. Management strategies for different adverse effects are provided.
This document provides an overview of treatment resistant schizophrenia, including definitions, prevalence, factors leading to treatment resistance, and management approaches. It notes that approximately 30% of schizophrenia patients do not adequately respond to initial treatment. Clozapine is identified as the gold standard treatment for resistant cases, though some patients remain resistant even to clozapine. The document discusses criteria for defining treatment resistance and response, as well as strategies for managing patients who are clozapine-resistant, including augmentation with other pharmacological or psychosocial approaches.
Use of prescribed psychotropics during pregnancyRiaz Marakkar
This document discusses the use of prescribed psychotropic medications during pregnancy. It begins by providing context on global pharmaceutical consumption patterns. It then discusses the prevalence of maternal mental health problems and the need for more research on risks of psychotropic medication use during pregnancy. The document categorizes medications from A to X based on risks in pregnancy. It discusses specific risks of various antidepressants, mood stabilizers, antipsychotics and other drug classes. It also addresses considerations for pharmacotherapy in pregnancy, balancing severity of the condition with risks. The document concludes by discussing risks and guidelines regarding breastfeeding while taking psychiatric medications.
Mental disorders in pregnancy may be under-diagnosed and can seriously impact the health and well-being of the mother and baby. A multi-disciplinary team approach is important for predicting, detecting, and treating mental disorders during pregnancy, which include depression, anxiety disorders, psychoses, bipolar disorder, eating disorders, and others. Psychological therapy is generally preferred over pharmacological therapy during pregnancy and breastfeeding, though medication may be considered for severe cases if benefits outweigh risks. Close monitoring is important for high risk patients to support good mental health outcomes for both mother and child.
Akathisia is a neurological side effect of antipsychotic and antidepressant medications characterized by inner restlessness and a constant need for movement. It is caused by a loss of dopamine function in the brain. The prevalence of akathisia ranges from 12.5-75% when taking first-generation antipsychotics. While difficult to diagnose, it can often be treated with benzodiazepines, beta-blockers like propranolol, or reducing the dose of the causative medication. Left untreated, akathisia can lead to poor treatment adherence.
This document summarizes several newer antipsychotic medications introduced after 2005, including paliperidone, iloperidone, asenapine, lurasidone, blonanserin, and cariprazine. It describes the indication, mechanism of action, pharmacokinetics, adverse effects, dosing, and precautions for each drug. It also briefly discusses brexiprazole and several investigational antipsychotics targeting non-dopamine receptors with limited success to date, such as pomaglumetad, sarcosine, and pimaverine.
Akathisia is a sensorimotor movement disorder caused by drugs like antipsychotics that block dopamine pathways in the brain. It involves feelings of inner restlessness and a compelling need to be in constant motion. Differential diagnoses include anxiety, agitation, and other drug-induced movement disorders. Treatment focuses on reducing the causative medication, correcting underlying conditions, and using anticholinergic or serotonergic drugs to alleviate symptoms.
Anxiety disorders are the most prevalent psychiatric disorders. They are characterized by feelings of fear, apprehension and worry that interfere with daily functioning. Common types include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, social phobia and specific phobia. Symptoms are often somatic in nature and patients frequently seek treatment in primary care settings. Effective treatments include cognitive behavioral therapy and antidepressant medications.
This document discusses novel neurotransmitters beyond the classical ones. It describes nitric oxide, carbon monoxide, hydrogen sulfide, endocannabinoids, eicosanoids, and neurosteroids. Nitric oxide is produced in neurons from arginine and acts through cGMP. It is involved in long term potentiation and erectile function. Carbon monoxide regulates olfaction and vasodilation. Hydrogen sulfide is produced from cysteine and acts as a gaseous messenger. Endocannabinoids like anandamide signal retrogradely through CB1 receptors. Eicosanoids are derived from arachidonic acid. Neurosteroids are synthesized in the brain from cholesterol and include allopregn
This document provides information on various classes of antipsychotic and antidepressant medications. It discusses the mechanisms and uses of tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors for treating conditions like depression. It also covers typical and atypical antipsychotics used to treat schizophrenia and other psychoses, describing their dopamine receptor blocking effects. Mood stabilizing drugs like lithium are mentioned for managing manic-depressive disorder.
1) The document discusses the etiopathogenesis of schizophrenia, including genetics, epidemiology, and various theories of causation.
2) Key points include that schizophrenia has a genetic basis but is influenced by environmental factors, with family studies showing around a 10% risk for first-degree relatives.
3) Several candidate genes have been implicated in increasing risk, such as dystrobrevin-binding protein 1 and neuregulin 1, but results have been inconsistent. Other factors explored include infections, immunological mechanisms, and neuroanatomical and neurochemical abnormalities.
Neuropsychiatric manifestations of head injurySantanu Ghosh
This document summarizes a presentation on neuropsychiatric aspects of head injury. It begins with an introduction discussing the prevalence of head injuries. It then covers the history of understanding head injuries, comparative diagnostic classifications, epidemiology, types and pathophysiology of head injuries including acute and chronic behavioral consequences. The presentation also discusses clinical features such as cognitive impairment, personality changes, mood disorders, anxiety, aggression and psychosis. It concludes with discussing prognosis and predictors of outcome following head injury.
Neuropsychiatric aspects of traumatic brain injuryAzfer Ibrahim
1) Traumatic brain injury (TBI) can cause various neuropsychiatric issues including mood disorders, cognitive deficits, and behavioral changes.
2) Common mood disorders after TBI include depression in 25-50% of patients in the first year, as well as increased risks of mania/hypomania and anxiety disorders.
3) Frequent cognitive deficits involve problems with memory, attention, concentration, language, and executive functioning that can cause long-term impairment.
This document provides information on the pharmacology of second generation antipsychotics. It discusses the history and development of antipsychotic drugs from chlorpromazine to clozapine. It describes the mechanisms of action of atypical antipsychotics including their effects on serotonin and dopamine receptors. The document classifies antipsychotics and examines the pharmacology of individual drugs like clozapine, risperidone, and olanzapine, covering their indications, mechanisms, side effects and interactions.
The document discusses bipolar disorder, also known as manic-depressive disorder. It is characterized by periods of elevated mood and periods of depression. During manic episodes, symptoms may include distractibility, insomnia, grandiosity, flight of ideas, increased activity or psychomotor agitation, risky behavior, and talkativeness. The causes of bipolar disorder are thought to include genetic, physiological, environmental, neurological, and neuroendocrine factors. Treatment involves hospitalization during severe episodes, as well as mood stabilizers, antipsychotics, antidepressants, ECT, psychotherapy, lifestyle changes, and substance abuse treatment.
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
Mood stabilizers for (Bipolar disorder, Schizophrenia and Mania) Bhudev Global
This document provides information about mood stabilizers, their uses, mechanisms of action, and side effects. It discusses several individual drugs used as mood stabilizers including lithium, valproate, and carbamazepine. Lithium is described as the classic mood stabilizer that works by decreasing sodium content load and levels of neurotransmitters like norepinephrine and dopamine. Valproate and carbamazepine are also described as having GABAergic effects that contribute to their antimanic properties. Common and rare side effects are outlined for each drug along with details about drug interactions.
1. Psychosis is common in epilepsy patients, occurring in 1-35% of cases and being 8 times more prevalent than in the general population.
2. Psychosis in epilepsy is classified as ictal, inter-ictal, post-ictal, or antiepileptic drug induced.
3. Diagnosis requires distinguishing psychosis in epilepsy from schizophrenia based on symptoms and personality features, and treatment involves careful use of antiepileptic and antipsychotic drugs due to interactions.
Resistant depression is difficult to treat depression that does not respond adequately to multiple antidepressant treatments. It is defined as failure to respond to 2 adequate trials of antidepressants from different classes. Depression is a leading cause of disability worldwide and resistant depression has a poor prognosis with high relapse rates. Causes of resistance include medical comorbidities, substance abuse, personality disorders, chronicity of depression, and inadequate previous treatment. Management involves re-evaluating treatment adequacy and using strategies like optimizing dose and duration, augmentation, switching medications, somatic treatments, and non-pharmacological therapies. Long-term maintenance treatment for 6-9 months or more is often required to prevent relapse.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
Schizophrenia is linked to over a dozen genes that regulate neuronal connectivity, synaptogenesis, NMDA glutamate receptors, and neuronal migration. It is also regulated by four genes: BDNF, Dysbindin, DISC1, and neuregulin. Schizophrenia is postulated to have four stages: stage 1 from birth to 15 with full functioning; stage 2 from 15-20 with subtle symptoms; stage 3 from 20-40 with acute positive symptoms and relapses; and stage 4 from 40-60 with prominent negative and cognitive symptoms and continuing disability.
Schizophrenia is a chronic brain disorder that causes difficulties with thinking, emotions and behavior. Symptoms usually emerge in late teens to early 30s and include hallucinations, delusions, disorganized speech and behavior. Genetics and environmental factors both contribute to its development. Treatment involves antipsychotic medications to manage symptoms as well as support for independent living. Relapse is common if medications are stopped, so ongoing monitoring and compliance are important for long-term management of the condition.
This document provides an overview of adverse effects of antipsychotics. It begins with an introduction and outlines the presentation scheme. Neurological side effects are discussed first, including neuroleptic induced movement disorders such as acute syndromes like dystonia, pseudoparkinsonism, and akathisia as well as tardive syndromes. Non-neurological side effects affecting endocrine, sexual, metabolic, cardiovascular, hematological, gastrointestinal, hepatic, dermatological and ophthalmological systems are also reviewed. Management strategies for different adverse effects are provided.
This document provides an overview of treatment resistant schizophrenia, including definitions, prevalence, factors leading to treatment resistance, and management approaches. It notes that approximately 30% of schizophrenia patients do not adequately respond to initial treatment. Clozapine is identified as the gold standard treatment for resistant cases, though some patients remain resistant even to clozapine. The document discusses criteria for defining treatment resistance and response, as well as strategies for managing patients who are clozapine-resistant, including augmentation with other pharmacological or psychosocial approaches.
Use of prescribed psychotropics during pregnancyRiaz Marakkar
This document discusses the use of prescribed psychotropic medications during pregnancy. It begins by providing context on global pharmaceutical consumption patterns. It then discusses the prevalence of maternal mental health problems and the need for more research on risks of psychotropic medication use during pregnancy. The document categorizes medications from A to X based on risks in pregnancy. It discusses specific risks of various antidepressants, mood stabilizers, antipsychotics and other drug classes. It also addresses considerations for pharmacotherapy in pregnancy, balancing severity of the condition with risks. The document concludes by discussing risks and guidelines regarding breastfeeding while taking psychiatric medications.
Mental disorders in pregnancy may be under-diagnosed and can seriously impact the health and well-being of the mother and baby. A multi-disciplinary team approach is important for predicting, detecting, and treating mental disorders during pregnancy, which include depression, anxiety disorders, psychoses, bipolar disorder, eating disorders, and others. Psychological therapy is generally preferred over pharmacological therapy during pregnancy and breastfeeding, though medication may be considered for severe cases if benefits outweigh risks. Close monitoring is important for high risk patients to support good mental health outcomes for both mother and child.
This document discusses mental health issues among women of reproductive age. It notes that depression is common, affecting around 8% of pregnant women and 11% of non-pregnant women. Poor mental health can negatively impact physical health, pregnancy outcomes, and child development. The document reviews risk factors for depression like stress, low social support, pregnancy complications, and chronic illness. It also discusses treatments like antidepressants and therapy.
The document discusses the teratogenicity of psychotropic drugs. It notes that while mental illness in mothers poses risks, discontinuing medication during pregnancy may not be possible. The guiding principles are to minimize exposure to untreated illness and psychotropics, continue prior effective medications, and monitor infants for potential drug effects if exposed during lactation or late pregnancy. Risks include teratogenesis, perinatal effects, and potential long-term neurodevelopmental impacts, though studies have shown mixed results. Among SSRIs, paroxetine carries greater risks while sertraline and citalopram generally pose less risk and are considered first-line treatments.
This document provides information on postpartum psychiatric complications. It begins with an introduction to postpartum psychiatric disorders including classification into postpartum blues, depression, and psychosis. It then discusses risk factors, signs and symptoms, and management. Key points include that postpartum depression affects approximately 13% of women, risk factors include a history of depression and complications during pregnancy, and treatment involves counseling, antidepressants, and monitoring for suicidal ideation.
Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy.
This document provides an overview of perinatal mental disorders (PMDs), including their epidemiology, etiology, risk factors, clinical features, diagnosis, and treatment. Some key points:
- PMDs refer to mental illnesses that occur during pregnancy or within 1 year postpartum, including depression, anxiety, OCD, and psychosis. Around 1 in 10 women develop postnatal depression.
- Biological and psychosocial factors contribute to etiology. Hormonal changes after birth and stress of motherhood can influence symptoms.
- Risk factors include prior mental illness, complications during birth, and lack of social support.
- Clinical features range from mild baby blues to severe postpartum psych
Postpartum depression is a mood disorder that can occur within the first year after giving birth. Hippocrates first described depression, which he called melancholia. Postpartum depression is triggered by hormonal and psychological changes following childbirth. Symptoms include sadness, anxiety, irritability and reduced concentration. Left untreated, postpartum depression can negatively impact both mother and child. Proper screening and treatment with SSRIs like sertraline can effectively treat postpartum depression while allowing for breastfeeding.
This document discusses drugs used during pregnancy and their risks. It begins by introducing the topic and explaining how pregnancy is divided into trimesters. It then discusses the FDA pregnancy categories, which indicate potential risk of birth defects. Examples are provided for various categories from A to X, with levothyroxine in Category A having minimal risk, and warfarin in Category X having clear risks that outweigh benefits. Specific drugs like metformin, lansoprazole, tramadol are also examined in more detail regarding their uses, risks found in animal studies, and any available human data.
Prenatal development: germinal, embryonic &fetal period; Factors that can have a serious negative impact on the development of the unborn: maternal health, radiation, maternal nutrition, medication and drugs, age of the parents, diseases in the pregnant woman and the emotional state of the mother.
Preconception care involves counseling women before pregnancy about nutrition, lifestyle factors, medical conditions, and other issues that could impact a future pregnancy. Components of preconception care include risk assessment, health promotion, medical intervention, and psychosocial intervention. The goals are to improve pregnancy outcomes, have a healthy baby, and support the mother's well-being.
For midwifery students.. Level 5.in the ordinary diploma
Care of woman in abnormal pregnancy, pueperium and labor..
This is purposely aims at making effective care for such woman and prepare the woman and child in safe motherhood after delivery and good health in their home based care and improve I'm reproductive health
1. Postpartum depression is a serious condition that can occur after childbirth and is distinct from the common "postpartum blues".
2. Risk factors for postpartum depression include hormonal changes during pregnancy and childbirth, a history of depression, lack of social support, anxiety during pregnancy, and stressful life events.
3. Screening for postpartum depression is recommended at the first postnatal obstetric visit using standardized scales, as the condition often goes undetected. Treatment involves psychotherapy such as interpersonal therapy and cognitive behavioral therapy, as well as antidepressant medication if needed.
Preconception care involves identifying and addressing biomedical, behavioral, and social risks to a woman's health or future pregnancy outcomes before she becomes pregnant. It is important because many birth defects and problems develop very early in pregnancy, before most women even know they are pregnant. Key components of preconception care include screening for nutritional deficiencies, infectious diseases, genetic risks, lifestyle factors like smoking, alcohol and drugs, and treating any issues identified. The goal is to promote the healthiest outcomes for both mother and baby.
This document provides information on perinatal and newborn care for people who use drugs. It discusses the pros and cons of continuing drug use or opioid substitution therapy during pregnancy and breastfeeding. It also covers neonatal opioid withdrawal, including causes, symptoms, and treatment strategies like skin-to-skin contact and breastfeeding. The document outlines steps for harm reduction programs to implement perinatal care services, such as training staff, providing pregnancy tests and referrals to healthcare, and developing protocols for opioid substitution therapy access during pregnancy and home births.
The document discusses various topics related to women's mental health including:
1. Common mental health problems women face like premenstrual syndrome, postpartum depression, and menopause.
2. Normal reactions and psychological changes during pregnancy, childbirth, and postpartum.
3. Psychiatric disorders that can occur during pregnancy and postpartum like postpartum psychosis.
4. Counseling approaches for issues like premarital counseling, marital counseling, genetic counseling, and battered wife syndrome.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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2. My goals
Bythe end of mypresentation I want
•Know the importance of managing mental illness during
pregnancy and lactation
•Know all data related to psychotropic drugs regarding
safetyand hazards on the baby during pregnancy and
lactations
3. Introduction
•Pregnancy and lactationconsidered stressingperiods in lifeofany
woman,so pregnant and lactatingwomenareat higher risk for
developing mentalillness.
•According to WHO, prevalenceof mentalillnesses amongpregnant
women about 10%and about 13% amongwomen inpostpartum
period
•Indeveloping countriesthis iseven higher, i.e. 15.6%during
pregnancy and 19.8%after child birth
•Depression, anxiety, psychosis, andothers mentalillnessescanaffect
pregnant and lactatingmothers
4. Estimated Prevalence of Selected Psychiatric Illnesses During
Pregnancy
Disorder Illness Estimated prevalence (%)
Depressive disorders
Major depression 13-20
Bipolar disorder Unknown
Anxiety disorders
General anxiety disorder 8.5
Panicdisorder 1-2
Post-traumatic stress disorder 3.5
Obsessive-compulsive disorder 0.2-1.2
Eating disorders Anorexia only 1.4
Bulimia only 1.6
Both anorexia and bulimia 0.7
Psychoticdisorders Post partumpsychosis
Other psychosis
0.1-0.2%
Unknown
5. Who is at risk ?
• Under certain circumstances ,any woman can develop mental disordersduring
pregnancy and after delivery , especially in the firstyear after delivery, but riskis
higher in patients with
• Previous mental illness,
70% of women with a history of recurrent major depressionwill relapse during
pregnancy
50% of women with untreated BipolarDisorderwill develop an episode in Pregnancy
• Poverty
• Extremestress
• Exposureto violence (domestic, sexual)
• Low social support
6. Mental illness and drugs which is more
serious?
Once the patient diagnosed to have mental illness, we have
to choose betweenone oftwo decisions
1-continue without medications and this may expose the
patient and the baby to ?certainrisk
2-start medications and this may exposethe baby to ?some
risk
So what is the decision that should be taken?
7. Effects of untreated mental disorders during
pregnancy and lactation on mother and baby
Both mother and baby will be affected.
• The mother may became unable to live normally ,loss of interest, self neglect, poorappetite and
sleep, in psychosis, she losses her touch with reality and become unable to care herself and her
baby.
• The risk of suicide is also a consideration, and in psychotic illnesses, the risk of infanticide, though
rare,must be taken into consideration.
• Babies during pregnancy are at high risk for under development and low birth weight, stillbirth and
pretermlabour.
• Motherwholosses her interest and unable to care her self , will be unable to satisfy herbaby
emotional and physical needs, and this may results in depression in babies too
( failure to thrive)
• Babies bornfor mentally ill mothers ,have high possibility to developsameillness in the future
8. Effects of psychotropics on
pregnant woman and her baby
during pregnancy and lactation
•What do you think about effect on the
mother?
•What do you think abouteffect on the
baby ?
9. Answers
•Positive effect on the mother.
•Positive effecton the baby but drugs may have side
effects on the baby as follow
10. Effects of psychotropic during pregnancy and after birth on
the mother and the infant. Continued
• Someof the psychotropic drugs may have side effectson baby, (congenital, neurological ,,respiratory,and cognitive effect)
Congenital effects Neurological side effects Respiratory side
effects
Cognitive side
effects
First trimester:heartdefects, (mainly valve,
septum),ex.. Ebstein's anomaly,(tricuspid valve
defect,)
anencephaly, and abdominal wall defects
spinal defects suchas spina bifida((folic acid
intake prior to conception and during first
trimester reducethe risk(SSRI’s and Lithium)
cleft lip(benzodiazepines)
Extrapyramidal(antipsychotics)
Withdrawal symptoms after
delivery;(varyin severity, with
some being self-limitedand others
requiringICU support and
prolonged hospitalization)
Floppy infant
syndrome (benzodiazepines)
SSRI’s in 3rd
trimestermay
cause persistent
pulmonary
hypertensionof
the newborn (not
sure)
lower cognitive
test
scores(sodium
valproate)
Effect of untreated mental illness may be greater than effect of drugs on the baby
11. Effects of psychotropic during pregnancy
and after birth on the mother and the infant.
Continued
•All the results from case reports and short term studiesbut no long
term studies, so it is difficultto formulate any generalizations
regardingthe safety of these medications.
•Generally for the current time, noabsolute contraindications for
any of the psychotropic drugs but some drugsare known to have
higher risk on the fetus thanother
•So we should consider the risk and benefits of medications on both
the mother andbaby
12. What to do?
•Would a physician tell a pregnant woman with epilepsy, ‘Stop
your meds and ride out the seizures until you deliver’?
•Are the medications of pregnant women with mental illness
somehow more “optional?
•Theanswer……
13. What to do?. Continued
•So pregnant and lactating womenwith mental illness should
be treated appropriately
•Treatmenthas good impact on both the mother and the baby
•Non treated women areat risk for serious complications and
also the baby
14. Management and consultation
To achieve the best management and get the best results
• We should diagnosis the problem as earlyas possible
• We should use non biological ways if wecan and so long as effective
• if obliged to use medications we have to use the safest drug
• We have to use singlemedicationas possible
• We have to start lowand increase slow
• We have to observe the outcome of medications anddecide accordingly
• We have to consult the patient about the drugs and clarifyingevery thing about the
drug andsharing the patient in taking the decision.
• Take care of drug interactions
• Folate must be prescribed
15. Consultation about medications
N/A No availabledata
PregnancyRisk Categories
A Controlled studies showno risk
B No evidence ofrisk inhumans
C Risk cannot be ruled out
D Positive evidence ofrisk
X Contraindicated in pregnancy
Lactation Risk Categories
L1 Safest
L2 Safer
L3 Moderatelysafe
L4 Possibly hazardous
16. Antidepressants
Medications Effect in pregnancy Lactation Medications Effect in
pregnancy
Lactation
Amitriptyline D L2 Mirtazapine C L3
Clomipramine C L2 Maprotiline B L3
Imipramine D L2 Bupropion B L3
Nortriptyline D L2 Venlafaxine C L3
Fluoxetine C L2 in older infants; L3
in neonatalperiod
Nefazodone C L4
Paroxetine D L2 Duloxetine C L3
Sertraline C L2 Safest (maprotiline and bupropion)
then (SSRI’’s), during pregnancy, nearly
all safe during lactation,MAOI should
be avoided because of congenital
abnormalities and drug interaction
Escitalopram C L3 in older infants
Fluvoxamine C L2
Citalopram C L3
17. Typical antipsychotics
Medications Effect in pregnancy Lactation
Haloperidol C L2
Trifluoperazine C N/A
Chlorpromazine C L3
Perphenazine C N/A
Pemozide C L4
Fluphenazine C L3
Thioridazine C L4
Haloperidol safest during pregnancy andlactation
18. Atypical antipsychotics
Medications Effect in pregnancy Lactation
Olanzapine C L2
Risperidone C L3
Aripiprazole C L3
Clozapine B L3
Quetiapine C L4
Ziprasidone C L4
Olanzapine and clozapine safest during pregnancy and lactation
19. Mood stabilizers
Medications Effectin pregnancy Lactation
Carbamazepine D L2
Divalproex acid D L2
Gabapentin C L2
Lamotrigine C L3
Lithium carbonate D L3
Oxcarbazepine C L3
Topiramate C L3
Carbamazepine, depakine and lithium are unsafe in pregnancy, others safe, and all are safe during
lactation but better to avoid lithium during lactation as kidney still immature, Gabapentin has been
reportedto cross into breast milk at almost 100% of the maternal levels so better to be avoided
20. Benzodiazepines
Benzodiazepines
Name Effectinpregnancy Lactation
Diazepam D L3
Clonazepam D L3
Alprazolam D L3
Lorazepam D L3
Bromazepam D L3
Not safein the first and third trimester, can beused during lactation
Benzodiazepines for insomnia
Flurazepam X L3
Triazolam X L3
Quazepam X L2
Not safeduring pregnancy,can beused during lactation
21. Sedative/Hypnotic/Antianxiety
Medications Effectin pregnancy Lactation
Clonidine C L3
Buspirone B L3
Hydroxyzine X-Growthrestriction, structural
anomalies and death at any time
in pregnancy
L1
Propranolol C L2
Zaleplon C L2
Zolpidem B L3
Some aresafe during pregnancy, all can be used during lactation
22. Medications for Side Effects
Medications Effect in pregnancy Lactation
Procyclidine
(kemadrine)
C L3
Benztropine
(Cogentin)
C L3
Biperiden (Akineton) C N/A
Bromocriptine C L5
23. Pregnancy and lactation summary
•Being pregnant and giving birth to achild is anexhaustingphysical
andemotionalexperience.
•A woman whohasor develops mentalillnessdeserves support, not
shaming.
•Assess thesituationand takedecision regarding starting biological
treatment or not as untreated mentalillnessmay affect motherand
baby badlyand effect maybe greaterthanpossibleside effect of drugs
•Sharing themotherisimportant
24. Pregnancy and lactation summary.
Continued
• Avoid medications during pregnancy without good reason
• If decision to start medications, weighrisk benefit ratio
• Try to chose single drug, the most effective drug withlowest possible side effects and
we may start with one drug during pregnancy andreplace by another one during
lactation.
• Patient falls pregnant on medication
1. Do not stop medications so long as controlled andthere is risk for relapse if stopped
2. Continuemeds at lowesteffective dose
3. EarlyUS and anomaly scan
4. Folate supplement
25. Pregnancy and lactation summary.
Continued
•Some medications need to be stoppedshortly before delivery for
safety of the baby but medications should be resumedagain after
delivery for avoiding relapse of mental illnessin the mother
•Delivery should be at hospital to manage any possible side effects
to the foetus and mother.
•For better practice in the future we need ,case reporting, more
researchesand long term studiesfor betterunderstanding of the
safety of psychotropic medications exposure in fetus and
neonates.
The tricyclic antidepressants are most commonly used for comorbid conditions and when other
treatments have failed. TCAs, which were once the treatment of choice for depression and panic,
remain effective and are not associated with teratogenesis. Doses may need to be adjusted as the
pregnancy proceeds. While data analysis has shown that exposure in pregnancy does not increase
the incidence of teratogenesis, neonatal withdrawal symptoms have been associated with these
medications, so careful monitoring of the newborn is essential.
Monoamine oxidase
inhibitors (MAOIs)
The MAOIs are contraindicated in pregnancy, based on animal studies that have reported
increased rates of congenital abnormalities.
2
Other non-SSRI
antidepressants
• buproprion
• mirtazapine
• trazodone
Limited data are available on the use of these medications
Low-potency typical antipsychotics (e.g., thioridazine) have been associated with increased risk of
mild malformations. High-potency typical antipsychotics (e.g., haloperidol) have not been associated
with increased risk.
Low-potency typical antipsychotics (e.g., thioridazine) have been associated with increased risk of
mild malformations. High-potency typical antipsychotics (e.g., haloperidol) have not been associated
with increased risk.
Low-potency dopamine blockade neuroleptics have been associated with an increased rate of congenital
abnormalities. High-potency dopamine blockade antipsychotic medications have not been
associated with congenital abnormalities. However, data are limited, and little or no information is
available on clozapine, ziprasidone, and quetiapine. Ziprasidone is not yet available in Canada, but
to date there are no reports of increased risk with exposure
The long-term developmental effects of neuroleptic exposure on the infant dopamine system and
receptors are still unclear. Recent data on haloperidol, olanzapine, and quetiapine are encouraging,
with no adverse effects reported. Clozapine has been associated with sedation, irritability, and
seizures in infants. There are limited data available on the other atypical neuroleptics, thus caution
is recommended.
Limited information is available regarding lamotrigine, topiramate, and gabapentin use in pregnancy.
Carbamazepine and valproic acid use during the first trimester has been associated with an
increased risk of neural tube defects, as well as minor and major fetal malformations, low birth
weight, and thrombocytopenia. Lithium use in pregnancy has been associated with a pronounced
increase in the rate of Ebstein anomaly; however, recent literature suggests that this rate is much
lower than previously reported (1 in 4000 vs 1 in 400). If lithium is continued in pregnancy, because
of the risk of decompensation, drug levels should be monitored carefully. The dose may need to be
increased by as much as 100% in pregnancy to maintain symptom control, but should be decreased
by at least 50% at the time of delivery to avoid toxicity in both mother and newborn.
Lithium has been reported to cross into breast milk at approximately 40% to 50% of the maternal
levels. The use of lithium during lactation is contraindicated because the neonatal kidney is still
immature and the risk for lithium accumulation is high. Low serum levels have been detected in
infants exposed to carbamazepine and valproate through breast milk, suggesting that these drugs
are compatible with breastfeeding. However, the possible association between these drugs and
thrombocytopenia and hepatotoxicity indicates that close monitoring of the infant is necessary.
Gabapentin has been reported to cross into breast milk at almost 100% of the maternal levels and
is, therefore, not recommended for use in breastfeeding women. Little information exists on the use
of lamotrigine and topiramate, so caution is advised.
Benzodiazepines
• lorazepam (short)
• clonazepam (med)
• alprazolam (short)
• diazepam (long)
Exposure to high-dose benzodiazepines in utero has been associated with newborn withdrawal
symptoms, including irritability and restlessness, apnea, cyanosis, lethargy, and hypotonia. No longterm
effects have been reported, although data are limited. Drugs with a short or medium half-life
(lorazepam, clonazepam) at the lowest effective doses should be used.
Case reports indicate that milk plasma concentrations vary from 0.1% to 0.5% of the maternal dose
for different benzodiazepines. Sedation, lethargy, impaired respiration, and withdrawal have been
reported in exposed infants after prolonged use. Therefore, if these medications are indicated, the
minimum dose required for symptom relief should be used, and the infant should be monitored regularly.