Exacerbation of psychotic disorder during pregnancy in the context of medication discontinuation.

Pregnancy is a time of great hormonal change and life stress. For women with a history of mental illness, pregnancy usually represents a time of increased vulnerability to exacerbation of symptoms, and poses difficult challenges surrounding decision-making about psychotropic use and subsequent fetal exposure during pregnancy. Pregnant women with mental illness may elect to discontinue effective pharmacotherapy because of perceived risks to the developing fetus. However, stopping psychotropic medications during pregnancy has been shown to significantly increase the risk of destabilization, especially in women with a history of psychotic disorders. The acute onset of psychosis during pregnancy presents many serious risks for the patient and fetus as illustrated in this case presentation. We present the case of a woman with severe and persistent mental illness who developed an acute psychiatric decompensation late in pregnancy following discontinuation of antipsychotic medication.