Perinatal

Question 1

Young woman treated involuntarily MHA, BPAD/Schizophrenia, now pregnant. Discussion around termination/treatment/pregnancy- important considerations (On lithium, quetiapine)

Answer 1

1. Ethical considerations and legal issues:
   potential termination of pregnancy in an involuntary patient->considerations of legal guardianship, potential for Clare to give informed consent, legal statutory requirements of a termination in an involuntary patient, second opinions/involvement of the consultant.
2. Information on risk to the infant should include risks of illicit and prescribed drugs as well as the risks of not treating (should pregnancy continue) and postpartum risks of relapse.
3. knowledge of concerns to infant of prescribed and illicit drugs, which may include lithium risk of heart defect (though low 0.1%), unknown risks of quetiapine, risks to development/size from illicit drugs, risks of coming off medication for baby (via suicide, poor maternal care, STD’s if promiscuous etc)
4. Psychoeducation re affective disorders having a higher risk of relapse postpartum; risks to mother if treatment withdrawn –relapse, suicide, poor self care, STD’s if promiscuous etc, alternative treatments and potential psychological sequelae of termination
5. Consider option of informed consent
6. Parenting support
7. Second opinion/peer review of situation/capacity
8. Family/stakeholders meeting