Psychotic denial of pregnancy: phenomenology and clinical management.

Psychotic denial of pregnancy in chronic mentally ill women may place the women and their fetuses at high risk of postpartum emotional disturbance, precipitous or unassisted delivery, fetal abuse, and neonaticide. Psychotic denial of pregnancy is illustrated with case reports from an inpatient program for pregnant mentally ill women. Women who denied their pregnancies tended to have a diagnosis of chronic schizophrenia, to have previously lost custody of children, and to anticipate separation from the baby they were carrying. The author suggests that treatment for such patients should take place in a setting that integrates comprehensive psychiatric and obstetrical care and may include pharmacotherapy, supportive psychotherapy, and evaluation of the patient's parenting skills and support network to assess whether she is able to keep her baby.