Bipolar, Schizophrenia, and Related Disorders

Description

General measures

Referral

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O28.8-9/ O90.9 + (F28/F29/F53.0-1/F53.8-9)

DESCRIPTION

Bipolar disorders (BD):

See Bipolar and related disorders for description and management in the perinatal period.

Note that:

• BD may present with antenatal or postnatal depression, hypomania, mania or psychosis.
• the index episode often occurs postpartum – may be no prior history of mental illness.
• risk of relapse in those known to have BD is increased in pregnancy and postpartum.
• women with bipolar disorder have a 1 in 4 chance of postpartum psychosis.
• BD is associated with increased risk of pre-eclampsia, placental abnormalities, preterm delivery, LBW and SGA babies, neonatal morbidity, and maternal suicide.

Schizophrenia and related disorders:

See Psychosis and Psychotic disorders for description and management.

Note that:

• Psychotic disorders are associated with poor pregnancy outcomes as with BD plus increased risk of diabetes, stillbirth, sudden infant death syndrome.
• The rate of deterioration from a non-psychotic to psychotic state may be more rapid in the postpartum period than usual. Take any reports of unusual behaviour by family members as serious and urgent.

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CAUTION: Psychosis
- Is a medical emergency; requires urgent hospitalisation.
- Always exclude delirium due to puerperal sepsis.
- May present with subtle, odd behaviour and/or thoughts; women may be blunted, withdrawn, agitated, or aggressive.
- High risk for harm to self or others, suicide, infanticide.
- May severely impair mother-infant bonding and child-care.
- Manage aggressive or disruptive behaviour (See Aggressive disruptive behaviour in adults).

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GENERAL MEASURES

• Manage all pregnancies as high-risk in conjunction with obstetrician and psychiatrist.
• Don't stop psychiatric medication – discuss with doctor/ psychiatrist.
• Actively monitor adherence to antenatal care and hospital referrals.
• Provide regular, frequent CHW home visits.
• Arrange for hospital delivery.
• Postpartum – keep in hospital, monitor mother and new-born, and ensure home-based care and outpatient follow-up before discharge

Factors requiring urgent admission, invoke the MHCA if necessary:

• Suicide risk.
• Any possible psychotic features.
• Risk to infant.

REFERRAL

All patients.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.9.2 Bipolar, Schizophrenia, and Related Disorders