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2009 | 9 | 1 | 7-28
Article title

Zaburzenia psychiczne w ciąży i poporodowe oraz ich leczenie

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Title variants
EN
Psychiatric disorders during pregnancy and postpartum period, and their treatment
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Abstracts
EN
Treating women with psychiatric disorders during pregnancy is a challenge for numerous reasons. Balancing the risk and benefits of the treatment is particularly important during pregnancy because both medication and maternal illness may have adverse effects on the fetus. Psychiatrists can prepare management decisions by reviewing the current literature. In the recurring disturbances, and with a risk of a serious relapse, it is often safer to continue the treatment, rather than to withdraw it. The physician and patient should discuss the known teratogenicity data, as well as acknowledge the unknown or non-quantifiable risks. The lowest effective doses should always be used (divided into several portions throughout the day); polytherapy should be avoided; doses should be adjusted to the period of pregnancy; preparations counteracting the toxic effect of the medication should be used (vitamin K, folic acid). In the prepartum period, the dose of the drug should be maximally reduced. The paper reviews the literature on the characteristic features of psychiatric illness during pregnancy and postpartum period and presents updated knowledge on teratogenicity, neonatal and neurobehavioural effects for different psychotropic drugs (SSRI, TCA, other antidepressants, mood stabilizers, neuroleptics, novel antipsychotics, benzodiazepines), and ECT.
PL
Leczenie kobiet ciężarnych z zaburzeniami psychicznymi wymaga uwzględnienia ryzyka związanego z chorobą i jej nieleczeniem oraz wynikającego z działania leków na rozwój i zdrowie dziecka. Decyzja o leczeniu musi uwzględniać aktualne dane z literatury. W zaburzeniach nawracających i z ryzykiem ciężkiego nawrotu często utrzymanie leczenia jest bezpieczniejsze niż odstawienie leku. Lekarz i pacjentka powinni omówić znane dane o ryzyku działania teratogennego leku, jak również inne dane o efekcie zaniechania i prowadzenia leczenia. Zawsze należy stosować najniższe skuteczne dawki, dzielone na kilka porcji w ciągu doby, unikać politerapii, dostosowywać dawki do okresu ciąży, podawać preparaty zapobiegające toksycznemu działaniu leków (witamina K, kwas foliowy). W okresie przed porodem należy maksymalnie zredukować dawkę podawanego leku. W pracy przedstawiono aktualne dane o zaburzeniach psychicznych w ciąży i połogu oraz o działaniu teratogennym i wpływie na kondycję dziecka i jego rozwój różnych leków psychotropowych (TLPD, SSRI i innych leków przeciwdepresyjnych, klasycznych neuroleptyków i nowych leków przeciwpsychotycznych, stabilizatorów nastroju, benzodiazepin) i elektrowstrząsów.
Discipline
Publisher

Year
Volume
9
Issue
1
Pages
7-28
Physical description
Contributors
  • Instytut Psychiatrii i Neurologii, ul. Sobieskiego 9, 02-957 Warszawa, tel.: 022 458 27 54
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