These relatively common disorders-18 percent prevalence overall-include panic attack, panic disorder, social anxiety disorder, specific phobia, separation anxiety disorder, and generalized anxiety disorder. All are characterized by irrational fear, tension, and worry, which are accompanied by physiological changes such as trembling, nausea, hot or cold lashes, dizziness, dyspnea, insomnia, and frequent urination (Schneier, 2006). They are treated with psychotherapy and medication, including SSRIs, tricyclic antidepressants, monoamine oxide inhibitors, or others.
Despite the relative high prevalence in childbearing-aged women, little speciic attention has been directed to anxiety disorders in pregnancy. Most reports conclude that rates between pregnant and nonpregnant women do not difer. One recent analysis of 268 gravidas with generalized anxiety disorder demonstrated that both symptoms and severity of anxiety decline across pregnancy (Buist, 2011).
From their review, Ross and McLean (2006) concluded that some of the anxiety disorders may have important matemalfetal implications. Some have been linked to preterm birth, fetal-growth restriction, and poor neurobehavioral development (Van den Bergh, 2005). Children with a history of in utero exposure to maternal anxiety are felt to be at increased risk for various neuropsychiatric conditions such as attention-deicit/ hyperactivity disorder (ADHD). Hunter and coworkers (2012) analyzed infants of 60 mothers with an anxiety disorder and found that auditory sensory gating-a relection of inhibitory neurotransmission-was impaired, particularly in ofspring of untreated women. Conversely, Littleton and associates (2007) found no excessive adverse pregnancy outcomes with "anxiety symptoms." One important exception is their link with postpartum depression (Vythilingum, 2008).
Anxiety disorders can be efectively treated during pregnancy with psychotherapy, cognitive-behavioral therapy, or medications. vlood and anxiety disorders coexist in more than half of women identified with either diagnosis (Frieder, 2008). hus, antidepressants listed in Table 61-3 are often the first line of pharmacotherapy.
Benzodiazepines are also commonly used to treat anxiety or panic disorders before and during pregnancy. Earlier casecontrol studies linked use of these CNS depressants to a possible increased risk for cleft lip and palate. A metaanalysis of more than 1 million exposed pregnancies, however, did not identiY a teratogenic risk (Enato, 2011). Benzodiazepines, especially when taken during the third trimester, can cause neonatal withdrawal syndrome, which persists for days to weeks after delivery.
his major form of mental illness afects 1.1 percent of adults (National Institute of Mental Health, 2016). Schizophrenia spectrum disorders are defined by abnormalities in one or more of the following domains: delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms. Brain-scanning techniques such as positron emission tomography (PET) and functional magnetic resonance imaging (MRI) show that schizophrenia is a degenerative brain disorder. Subtle anatomical abnormalities are present early in life and worsen with time.