Schizophrenia in the postnatal period

What is schizophrenia?

Schizophrenia is a severe mental illness that is associated with much stigma and misinformation. While some people with schizophrenia experience only one or a few episodes, for others it may remain an ongoing health condition. People with schizophrenia often also experience depression and/or anxiety.

How common is schizophrenia?

Schizophrenia is experienced by 1 in 100 people in the Australian population.

What causes schizophrenia?

There is no known single cause of schizophrenia but we do know about factors that make it more likely.

• Genetic factors — the risk increases to 10 in 100 if you have a parent with schizophrenia
• Biochemical factors — an imbalance of certain biochemical substances in the brain may be involved in development of schizophrenia
• Stress — stressful events often precede the onset of schizophrenia
• Alcohol and other drugs — harmful alcohol and drug use may trigger symptoms in people who are vulnerable to developing schizophrenia

Signs and symptoms of schizophrenia

The main symptoms of schizophrenia are:

• Delusions — false beliefs of persecution, guilt or grandeur, or being under outside control
• Hallucinations — these most commonly involve hearing voices
• Thought disorder — speech may be difficult to follow with no logical connection

Other symptoms of schizophrenia include:

• Lack of drive
• Thinking difficulties
• Blunted expression of emotions
• Social withdrawal
• Lack of insight

Treatment for and management of schizophrenia in the postnatal period

Schizophrenia can be managed through a range of different types of treatments, which may be used alone or in combination.

Talking therapies

Talking therapies can be very helpful in treating symptoms of depression and anxiety. They can help you recognise and change the negative thinking and feelings that depression brings. They also give you useful tools to stop anxiety coming back. Talking therapies include:

Cognitive-behavioural therapy (CBT) 

The cognitive (or thinking) part of this therapy teaches you to think logically and challenge negative thoughts. The behaviour part helps you change the way you react in situations and can help you to get involved in activities that you have been avoiding or have stopped doing

Interpersonal therapy (IPT)

IPT helps you to find new ways to connect with others, overcome losses, challenges and conflicts that you may have.

Registered practitioners with appropriate training and experience provide talking therapies for individuals or groups. You can find these types of professionals by searching the COPE Directory.

Medication

Antipsychotics

The main medicines used to treat schizophrenia are called antipsychotics. These assist with symptoms such as delusions or hallucinations. Some antipsychotics also help improve problems of mood, thinking and socialising and anxiety or agitation. 

Other than clozapine, antipsychotics can be safely used when breastfeeding. As some antipsychotics increase weight gain, it is good to talk to your doctor or another health professional about managing your weight. Depending on your symptoms, your doctor may also prescribe other medicines.

Antidepressants

These are used to treat symptoms of depression and/or anxiety. Antidepressants that can be safely used when breastfeeding are called selective serotonin reuptake inhibitors (SSRIs). Your doctor may also suggest another type of antidepressant called tricyclic antidepressants, especially if they have worked for you in the past.

Mood stabilisers

Mood stabilisers help to reduce the likelihood of your symptoms recurring (relapse). The most common mood stabiliser is lithium but this is not safe if you are breastfeeding. Other mood stabilisers that may be used are carbamazepine, lamotrigine and sodium valproate. However, sodium valproate is not safe for use in pregnancy so it should not be used unless you are taking contraception.

It is important not to change or stop taking your medicines without talking to your doctor.

Hospital care

Women with schizophrenia who experience relapse in the postnatal period may require admission to a psychiatric hospital. This allows the woman to be monitored by health professionals in a safe environment. Some hospitals have mother and baby units, where the baby can stay with the mother. This allows the mother to remain close to her baby and encourages ongoing close contact between them.

This approach may not be appropriate for women who are severely unwell and unable to care for the baby and/or when there are concerns for the safety of the baby. 

Following discharge from hospital, you and your baby will need ongoing support and monitoring by a specialist mental health professional.

Additional support for schizophrenia after having a baby

Women with schizophrenia may find the early postnatal period distressing and have difficulty bonding with the baby.

As well as seeing your doctor regularly, it is helpful to have support from your partner and/or family or from a nanny. Having this type of support overnight will mean that you can sleep. This is important as lack of sleep can trigger a relapse.

Your doctor or maternal child health nurse may also suggest that you attend a special group to help you with parenting skills.