The nine months of pregnancy, plus the following few months after giving birth, can be an emotionally vulnerable time in a woman’s life. A recent case published in The Primary Care Companion For CNS Disorders describes the clinical circumstances of a young woman ultimately diagnosed with postpartum psychosis despite having no previous history of mental disorders before the birth of her child.
Diagnosing this woman was broad and challenging, said Rubiahna Vaughn, MD, who is one of the authors of the study. Her case is a perfect example of the complex neuropsychiatric symptoms in the postpartum period and the need for specialized programs aimed at women in their reproductive years, she added.
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Beyond the psychiatric symptoms, there are unique hormonal, immunological, and autoimmune factors that come into play when a woman is pregnant or postpartum which can require specialized care, explained Vaughn, a psychiatrist with the department of psychiatry and behavioral sciences at Montefiore Medical Center in the Bronx, New York. And because it is a relatively short period of time in a woman’s life, there is an urgent need to address their problems as quickly as possible.
“We know that one in 13 women experience depression during pregnancy and that increases in the postpartum to one in seven,” she said.
Reproductive psychiatry is an emerging field. Clinicians in this specialty care for women who are pregnant and up to four months postpartum with psychiatric disorders like major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bipolar disorder, schizophrenia, and various anxiety disorders, Vaughn said. They may be using substances, experiencing suicidal ideation, or, like the patient in her case study, showing the signs and symptoms of postpartum psychosis. “We really run the whole gamut in terms of the patients that we see,” she said.
The Montefiore program works in partnership between the department of psychiatry and the department of obstetrics and gynecology. They train psychiatry residents through didactic and required clinical rotations on how to provide evidence-based psychiatric care to women across their reproductive life cycle. Over the next few years, Vaughn said she hoped the hospital would be able to build a comprehensive women’s mental health center that provides not only psychiatric services but also individual and group psychotherapy, social work, and case management.
Vaughn also said she was pleased that the program has been well-received by her colleagues in other specialties, particularly by OBGYNs who are “very much aware that their patients are struggling with untreated psychiatric disorders and untreated substance use disorders.”
“Other physicians are reaching out to us all the time with referrals and also curbside questions and e-consultations,” she said.
Vaughn said that it is particularly important to offer reproductive psychiatry in places like New York, which has the second-largest number of psychiatrists in the country, but the vast majority of those doctors don’t accept insurance or receive any training on treating psychiatric disorders related to pregnancy or the postpartum period.
“Many doctors, even if they’re taking care of these patients, might refuse to provide psychiatric medications to women who are pregnant or breastfeeding because they mistakenly think they are unsafe for the mother or the fetus or the baby,” she said.
Montefiore is one of an increasing number of women’s mental health and reproductive psychiatry programs offered at hospitals throughout the country. Vaughn said she hoped that there will be an evolution in this subspecialty that emphasizes the importance of a thoughtful approach to the management of psychiatric disorders during the reproductive years of women.
“It is very meaningful that if you’re a medical center, you’re able to provide expert reproductive psychiatry care to patients who are publicly insured and for whom it’s really difficult to find access to that expertise in a timely manner, even in a city like New York,” she said. “And so I think one of the biggest successes is that we’re training the next generation of psychiatrists to be able to provide evidence based care for women.”
