Schizophrenia has a major genetic component, and there is a 50-percent concordance in monozygotic twins. If one parent has schizophrenia, the risk to ofspring is 5 to 10 percent. Some data, including a strong association between schizophrenia and the velocardiofacial syndrome, suggest that associated genes are located on chromosome 22q 11 (Murphy, 2002). But sophisticated gene mapping studies clearly show that schizophrenia is not related to a single gene or mutation. Instead, multiple DNA variants likely interact to lead to schizophrenia (Kukshal, 2012). Other putative risks for subsequent schizophrenia in an exposed fetus include maternal iron-deiciency anemia, diabetes, and acute maternal stress (Insel, 2008; Malaspina, 2008; Van Lieshout, 2008). hese remain unproven, as does the association with maternal inluenza A infection.
Signs of illness begin approximately at age 20 years, and commonly, work and psychosocial functioning deteriorate over time. Women have a slightly later onset than men and are less susceptible to autism and other neurodevelopmental abnormalities. hus, many investigators theorize that estrogen is protective. Afected women may become pregnant before symptoms manifest. With appropriate treatment, patients can experience a decrease or cessation of symptoms. Within 5 years from the irst signs of illness, 60 percent have social recovery, 50 percent are employed, 30 percent are mentally handicapped, and 10 percent require continued hospitalization (American Psychiatric Association, 2013).
vlost studies have not found adverse maternal outcomes, although researchers in a Swedish study noted increased rates of low birthweight, fetal-growth restriction, and preterm delivery (Bennedsen, 1999). In a study of more than 3000 pregnancies in schizophrenic women, Jablensky and coworkers (2005) reported that placental abruption was increased threefold and "fetal distress" -vaguely deined-was increased l.4-fold.
Because schizophrenia has a high recurrence if medications are discontinued, continued therapy during pregnancy is advised. Ater 40 years of use, no evidence links the conventional or "typical" antipsychotic drugs listed in Table 61-3 and adverse fetal or maternal sequelae (McKenna, 2005; Robinson, 2012; Yaeger, 2006). Because less is known about "atypical" antipsychotics, the American College of Obstetricians and Gynecologists (2016b) recommends against their routine use in pregnant and breastfeeding women. In response to adverse event reports, the Food and Drug Administration (2011) issued a safety communication alerting health-care providers concerning some antipsychotic medications. hese have been associated with neonatal extrapyramidal and withdrawal symptoms similar to the neonatal behavioral syndrome seen in those exposed to SSRIs.
hese include anorexia nervosa, in which the patient refuses to maintain minimally normal body weight, and bulimia nervosa, in which binge eating is usually followed by purging or excessive fasting to maintain normal body weight (Zerbe, 2008). Eating behavior disturbances largely afect adolescent females and young adults. With anorexia and bulimia, the lifetime prevalence for each is 2 to 3 percent (National Institute of Mental Health, 2016).