Sexually transmitted diseases and unwanted pregnancies in chronically ill psychiatric patients

mA 28-year-old woman, who had been treated in hospital on numerous occasion for chronic schizophrenia, invariably refused to consider using contraception, although she was heterosexually active and not in a stable relationship. Children from two previous pregnancies had been given up for others to raise. This case illustrates a dilemma commonly faced by health care professionals in managing sexual risk-behaviours of chronically ill psychiatric patients. The patients is at risk of contracting a sexually transmitted disease (or may have already done so), as well as at risk of pregnancy ending in a child being given up for another to raise. During pregnancy the woman is at risk of experiencing added psychological stress that may precipitate an illness episode, and her medications may have a deleterious effect on the fetus. If she chooses to raise her child, the stress of parenting must be considered, as well as effects on the child of the mother's illness episodes. It must also be considered that the patient's mental illness may impair her capacity to make decisions about contraception. Guidelines for ethically justified responses to such cases are considered in this editorial.