Mental health articles

OF mental health care and mentally ill

Schizophrenia and schizoaffective disorder

Schizophrenia develops in one per cent of all populations, regardless of cultural or socio-economic status. It is a severe illness which affects many important aspects of functioning, and tends to be chronic.

Successful parenting is likely to be compromised from pre-conception onwards for women (and men) with schizophrenia. For many years, it was widely known that women with schizophrenia were relatively infertile(Rimmer & Jacobsen, 1976; Nimgaonkar, 1998; Haverkamp, Propping &Hilgeer, 1982). It has been suggested that the social skills deficits of women with this condition reduces the likelihood of them marrying. Certainly, the treatment methods used during much of the 20th century increased thepossibility that this group of people would not have children. Living insingle-sex hospital wards clearly prevented pregnancies, and the traditional anti-psychotic medications produced an increase in prolactin, with an associated reduction in fertility (Meaney & O’Keane, 2002). The newer antipsychoticsgenerally do not have this effect, and as most women with this illness now usually live in the community, the possibility of conception is some what increased (Neumann & Frasch, 2001).

In pregnancy there are further problems. There are significantly increased risks for stillbirth, infant death, pre-term delivery, low birth weight and small for gestational age for the offspring of women with schizophrenia (Nilssonet al., 2002), the latter two situations compromising infant development.Bennedsen et al. (2001) found some similar outcomes, and suggested that thein creased risk of sudden infant death, in particular, needed to be considered in the context of increased cigarette smoking, substance abuse and psychotropic medication—all of which are more likely in this population.The safety and potential effects on the foetus of psychotropic medication inpregnancy are still uncertain (Committee on Drugs, 2000).

In neonates, Schubert, Blennow & McNeil (1996) showed reduced arousal inthe offspring of women with schizophrenia, and suggested that there may bea neuro-developmental disorder.

Thus, even prior to birth, hazards for these infants are substantially increased.The specific symptoms, lifestyles and treatment of the women now also add further risks (Yoshida et al., 1999).

The so-called ‘positive symptoms’ of this unfortunate condition include hallucinations, usually auditory, which may describe the woman’s actions or‘tell’ her how to behave. Delusions are fixed, false beliefs, which may impact dramatically on a person’s life. For instance, if a woman believes that everyone is against her (persecutory delusions), she may closet herself in herhome, afraid to venture out. Parenting under these circumstances can be very compromised. Not only will the infant be denied normal day-to-day input from the outside world, but the mother may not even be able to provide the basic necessities of life. ‘Positive’ symptoms are often amenable to medication, but people with this illness often find it difficult to accept that they have an illness, and therefore do not comply with treatment.

The ‘negative symptoms’ are usually less responsive to medication, and thusthe impact on infants can be significant. Negative symptoms include a lack ofdrive, energy and motivation. A sufferer finds little joy in the world, may findit difficult to organise her day-to-day life, making infant care difficult. At thefine-tuning level, cueing in to an infant may be difficult, and this will diminish the likelihood of secure attachment. An infant whose mother is withdrawn and does not read his/her signals may develop an avoidant attachment (Riordan, Appleby & Faragher, 1999) or may live in a chaoticworld in which other attachment difficulties are noted (Hipwell & Kumar,1996; Snellen, Mack & Trauer, 1999).

The net result of all of these problems is that women with schizophrenia have a much reduced chance of keeping custody of their children (Miller &Finnerty, 1996). Thus, early monitoring, teaching and general interventions are essential.

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