Diagnosis and treatment of bipolar disorder in pregnant women.
Diagnosis and treatment of bipolar disorder in pregnant women.
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DOI：
10.1016/s1068-607x(00)00030-5
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发表时间：
2000-05-01
期刊：
影响因子：
--
通讯作者：
Hales
中科院分区：
文献类型：
--
作者：
Hilty;Kelly;Hales
与抑郁症和焦虑症相比，双相情感障碍在妇产科（ob/gyn）实践中相对罕见，但患者及其后代预后不良的风险很高。在当今的管理式护理环境中，妇产科医生承担着越来越多的责任，他们要么独立工作，要么与精神科医生合作。双相患者的临床表现可能包括躁狂和/或抑郁，除了伴随怀孕的情绪和身体变化的更轻微的情绪波动。鉴别诊断的关键问题是排除可能可逆的躁狂症的内科、外科、药物和物质病因。指征常规，紧急和紧急转介到精神科医生进行审查。考虑怀孕的双相情感障碍妇女的治疗包括孕前计划教育，包括患者、家庭、精神科医生、妇产科医生和母胎医学专家。妊娠双相情感障碍妇女的治疗包括个体化的药物风险/收益评估、药物监测水平和服药依从性，持续的患者教育，以及妇产科医生、母胎医学专家和精神科医生之间的合作。
Bipolar disorder is relatively rare in obstetrics and gynecology (ob/gyn) practice compared with depressive and anxiety disorders, but there is a high risk for poor outcomes for patients and their offspring. Ob/Gyn physicians are assuming increasing responsibility for the care of these patients in today's managed care environment, working independently or in collaboration with a psychiatrist. The clinical presentation of bipolar patients may include mania and/or depression, in addition to more minor mood fluctuations that accompany the emotional and physical changes of pregnancy. The key issue in the differential diagnosis is to rule out medical, surgical, medication, and substance etiologies of mania that are potentially reversible. Indications for routine, urgent, and emergent referrals to a psychiatrist are reviewed. Treatment for bipolar women considering pregnancy includes prepregnancy planning education, involving the patient, family, psychiatrist, ob/gyn physician, and maternal-fetal medicine specialist. Treatment for pregnant bipolar women includes an individualized risk/benefit assessment regarding medication, monitoring levels and adherence to medication if it is used, ongoing patient education, and collaboration between the ob/gyn physician, maternal-fetal medicine specialist, and psychiatrist.