Addressing Crises in Teenage Pregnancy

Background: Adolescent pregnancy is a major public health concern with medical,psychiatric, and social implications. Within this population, there is an elevated rate ofco-occurring psychiatric conditions including mood disorders, anxiety disorders, suicidality,and substance use. However, little is known about the assessment and treatment of adolescentpregnancy within the context of these co-occurring psychiatric conditions, particularlyin an emergency situation. Objective: This article utilizes a case report to illustrate the challenges faced in consultativepsychiatry in the assessment and treatment of a pregnant suicidal youth with a complex psychosocialhistory. Topics addressed include: 1) The role of childhood trauma and suicidalityin adolescent pregnancy 2) A consideration of the risks and benefits of treating adolescentswith psychotropics during pregnancy. Method: A literature search was performed with the key words of adolescent, pregnancy,child sexual abuse and psychiatric illness. In addition, expert opinions of a reproductive psychiatristand a psychiatrist who had specialized in addiction and adolescents were enlisted onkey aspects of the case formulation and treatment. Results: Several studies were found that focused on depression, substance abuse and traumain adolescent pregnancy. There were more studies that looked at psychopharmacologicaltreatment in adult pregnant women and a few that focused on adolescents. Conclusion: Addressing the crisis of psychiatric illness in adolescent pregnancy requires athorough approach in understanding the severity of the illness and the contribution of childabuse and suicidality. Psychotherapeutic interventions are most certainly always necessaryand beneficial when dealing with this population. Deciding when to start and maintain medicationduring pregnancy should be individualized, with considerations of the risks of untreatedillness and of medication exposure.