Women and Psychosis: A Guide for Women and Their Families
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In today’s society, many choices exist. A woman can choose to marry, live with a partner or stay single. A woman may feel
strongly about the kind of relationship she would like to have. Yet family or friends may still pressure women to make specific
Having a psychotic illness can greatly affect a woman’s self-esteem. She may worry that people close to her, including a partner,
will reject or leave her. These feelings are normal. It helps to discuss them with a trusted friend, family member or counsellor.
Sometimes a partner can have fears about the illness that are unfounded. He or she can overcome these fears by getting informed
and talking about concerns with a health care professional.
At times, a woman may not feel good about herself, and may be lonely. If so, she may be tempted to become intimate with someone
she would not normally choose. It is very important not to act impulsively. A woman should never put herself at risk. Often,
talking to a trusted friend or counsellor about feeling lonely can lead to better solutions.
Some women choose to have children, and some women choose not to have children. Women can lead fulfilled lives without children.
These women value their independence, and some choose to focus on other aspects of their lives, such as their jobs or interests.
Deciding whether to have children is more complex if a woman has had a psychotic illness. Typically, women have many questions:
- Will my child inherit my illness?
- Will I be able to take care of my child?
- If I get pregnant, should I go off medication?
- If I keep taking my drugs, will this harm my unborn child (fetus)?
- Do you have any symptoms that affect your daily activities or relationships?
- How high is your energy level? Do you concentrate well?
- Do your drugs make you drowsy?
- Have you had any recent stresses? How well did you cope?
- Have you recently relapsed and found that you were less able to look after yourself or do normal routines? Who looked after
things during this time?
- Was anyone concerned about your ability to look after yourself?
- Are your doctor and health care providers concerned about your ability to care for a baby?
- How is your partner’s health?
- How well does your partner cope with stress?
- How well does your partner understand your illness and its treatment?
- How much is your partner able to help you when you are ill?
- What are your partner’s views on having children?
- Is your relationship with your partner likely to continue?
- Do you expect to be a single parent?
Your living situation and finances
- Are you living in a place that would suit a baby (e.g., safe spaces to play, a separate bedroom)? Where you live will affect
how well you can look after your child. Subsidized apartments for families may be available.
- Would you have enough money to provide adequately for a baby? To buy food, clothes, toys, other basics?
- Do you have family members or friends who could help you with child care? Give financial help if needed?
- If you did relapse and needed to be in hospital, who would care for your child?
- If no one could help and child welfare had to take your child into care, how would you feel?
- Would you allow a worker to come to your home and help you care for your child if this was needed?
- Would you be willing to attend parenting classes or groups to learn new skills?
- How would you cope if your child developed a mental illness, or had learning or behaviour problems, and was harder to manage
- Would you be willing and able to get help for your child if she or he had any special needs?
Talk openly with your partner, other family members, your doctor and other members of your health care team. Note the issues
that concern everyone. Then brainstorm about how to address these issues. Learn what else you will need to know and how you
might find this information. Being well-informed can help a woman and her partner decide whether or not to have a child. It’s
useful to know about genetic risks, taking medication when pregnant, childbirth and child care.
It depends what the diagnosis is. Schizophrenia is thought to be a complex genetic disorder. That means it is inherited, but
not in a straightforward way. If one parent has schizophrenia, a child has about a one-in-10 chance of inheriting the illness.
This is about 10 times more than if the parent did not have schizophrenia. If both parents have schizophrenia, the chances
of having a child with the illness are about one in two. The actual risk will depend to some degree on the specific type of
psychosis you have. The mental health of the other parent is also a factor. Right now, we do not know exactly how the genes
for schizophrenia or other psychoses are transmitted. Factors such as infection, vitamin deficiency, poor nutrition or substance
abuse during the mother’s pregnancy may increase the risk. Trauma during delivery may also play a role.
The first trimester of pregnancy is a crucial time for making choices. Women must decide whether to continue with the pregnancy
and the drug regime. Antipsychotic drugs are considered relatively safe for the fetus, but they may slightly raise the risk
for congenital anomalies, or birth defects. No specific antipsychotic drug is known to be riskier than another, although more
is known about the safety of the older antipsychotics.
Some mood stabilizers cause problems for the fetus, and must be carefully monitored. Most antidepressants are fairly safe
but, like all drugs, should be used carefully during the first trimester of pregnancy.
You need to discuss pregnancy with your doctor and treatment team. They will review your medications and health. They will
carefully consider the health of both you and your fetus. You will also be advised on how to manage drugs during your pregnancy.
The Motherisk program at the Hospital for Sick Children in Toronto, Ontario, is an international resource for information
on using medications in pregnancy. Consulting with the Motherisk program is highly recommended (Tel.: 416 813-6780; website:
Pregnancy should be carefully planned. Doctors recommend that women start folate supplementation before pregnancy begins to
prevent neural tube defects. These defects can occur in fetuses of all women, but may be more prevalent among women taking
medications or women who are overweight. Women should have frequent mental health and prenatal follow-up during pregnancy.
Ideally, all interested family members should be involved. This is because their support will be needed once the baby is born.
The pregnancy itself does not tend to be a very hard time, but a woman can be very vulnerable in the postpartum period. Caring
for an infant is stressful. Stress will be much greater if a partner or family members are not supportive.
Breast-feeding is important for the mother-baby bond and the health of the baby. There are ways to minimize the amount of
drug that is transmitted to a breast-feeding infant. This is a very stressful and vulnerable time for women who have experienced
psychosis, and antipsychotic drugs should not be abandoned during breast-feeding.
Home monitoring visits need to be frequent after childbirth. Visits ensure that active psychotic symptoms are kept in check,
and that the mother is not overly sedated or low on energy. Vulnerable women are best to stay longer in hospital after delivery.
They also need to organize a full network of support at home. This support should be in place for at least the first six months.
Caring for an infant challenges any woman. You will face extra challenges if you have had psychotic symptoms. You may feel
sedated, which is a common side-effect of drug treatment. Or psychotic symptoms may persist. Other factors can be very stressful.
These include economic hardship, alcohol or other drug use, single parenthood and a lack of supportive relatives and friends.
The chances of being unable to care properly for your baby, and maybe for yourself, are relatively high. In cases like this,
a child welfare agency needs to be involved. This is in the best interests of the child and also lessens your responsibility
You may worry that a child welfare agency will take away your child for good if they see you struggling. The job of child
welfare workers is to ensure the safety and well-being of children. Their goal is not to break up families. Sticking to treatment
and working with your treatment team and child welfare worker will give the best possible result. They will increase the chances
of your child being able to remain with you or being returned to you as soon as possible. Should you need a break from child
care, you are strongly advised to plan ahead about who is the best person to care for your child when you are unable to do
Some infants of parents with a psychotic illness develop slowly. They may be harder to care for than other infants. Having
extra help in these cases is important. Your doctor and treatment team can help you arrange this. The department of public
health offers parenting support. So do many community centres.