Women's Mental Health
Avital Fischer, MD PhD
Resident Physician
Stanford Health Care
PALO ALTO, California
Mira Zein, MD
Clinical Assistant Professor
Stanford Health Care
San Mateo, California
Matthew Gunther, MD, MA (he/him/his)
Clinical Assistant Professor
Stanford University
Palo Alto, California
Background: There is a shortage of mental health professionals and specifically reproductive psychiatrists. Managing antipsychotic medications in pregnancy is a clinical challenge due to the sparsity of longitudinal cohort data. Weighing the risks of untreated mental illness in pregnant women with the risks of medication exposure requires a nuanced discussion with patients that primary care providers may not be comfortable with.
Method: This work reviews the literature on integrated models of peripartum mental health treatment and antipsychotic medication specifically. This will be done with the focus on a clinical case who presented to the internal medicine clinic at Stanford Health Care and was managed with the integrated behavioral health model. A clinical guide will be developed to help primary care practitioners prescribe antipsychotics pre-partum, intra-partum, and post-partum with the help of psychiatry input in the integrated behavioral health model. A pre-post survey will be administered to a target sample of N=50 residents and assess the comfort with managing antipsychotics during pregnancy in the primary care setting.
Case: This is a 30-year-old female with a history of schizophrenia who had one prior psychiatric admission, had been stable on a Olanzapine which was decreased to 1.25mg in the context of sedation and the desire to get pregnant (previously had been on 10mg of Olanzapine). Patient continued to take low dose Olanzapine during pregnancy and after delivery, 4 months postpartum, she presented to the emergency department for decompensated psychosis and was admitted to psychiatry. She was stabilized on 25mg Olanzapine + 150mg Seroquel, discharged and presented to the internal medicine clinic utilizing integrated behavioral health (IBH) for a post-hospital discharge follow-up.
Discussion: The proposed work will focus on the treatment recommendations for mothers who were on antipsychotic medication prior to conception and how to manage choice of antipsychotics prior to conceptions, throughout pregnancy and during lactation. This will be done with a specific focus on the IBH model and be based on clinical interactions in the internal medicine outpatient clinic at Stanford Health Care. After this case, psychoeducational interventions including presentations, indirect supervision, and an algorithm will be generated evaluated in the primary care resident clinic . Pre and post intervention surveys with resident primary care providers will be presented.
Implications: This work proposes innovative ways to integrate reproductive mental health care in primary care and increase dissemination of knowledge of reproductive psychiatry to primary care physicians.
Presentation Eligibility: not previously published or presented
Diversity, Equity, and Inclusion: This work helps dissemination of knowledge on how to treat women with psychiatric illness who are pregnant in the primary care setting who may not have access to psychiatric care and therefore increases diversity, equity and inclusion of maternal mental health care.
