[Parenting capacity of mothers with schizophrenia]

Recent studies indicate that the pregnancy rates of mothers with schizophrenia do not differ significantly from those of the general population. Mothers' severe mental illness, combined with poor social support and comorbidity, may significantly affect her parenting capacity. However, the poor quality of parenting by psychotic mothers should not be taken for granted, in advance. Some of them may become excellent parents while other may abuse their children and finally lose custody because of this. The parenting capacity is significantly influenced by the existing insight of patient-parent's disease. Assessing the parenting capacity comprises the measurement of insight and of the risk of child abuse as well. Factors associated with increased risk for child abuse are: (a) active psychiatric symptomatology, (b) history of violent behavior in the past, (c) maternal history of abuse during childhood, (d) dangerous domestic environment, (e) stressful events and poor social support to the mother and (f) unrealistic parental expectations. These factors should be assessed both clinically and by using the appropriate psychometric tools. Tools which have been widely used for this purpose are: (a) "Schedule for Assessment of Insight-SAI", (b) "Childhood Trauma Interview", (c) "Home Observation for the Measurement of the Environment Inventory-HOME" and "Home Screening Questionnaire -HSQ", (d) "Parental Stress Inventory-PSI", "Swedish Parenthood Stress Questionnaire-SPSQ", "Arizona Social Support Inventory" (e) "Parent Opinion Questionnaire-POQ". Interventions to ensure a more adequate parenting capacity should be focused on family planning: mothers with severe mental illness have poor knowledge about reproductive and contraception issues. Their pregnancies are mostly not planned. It is important for the family planning to be tailored according to the specific needs of schizophrenic mothers and to take into account the following issues: (a) the severity and the duration/chronicity of the disease, (b) the onset of the disease in relation to the gestational period, (c) the education of mothers with schizophrenia considering their double patient/mother role. An educational program should train the mother to recognize early signs of the disease, comply with medication, increase her empathy towards the baby and reduce any distorted perceptions about it. The treating, assessing, educating and preventing programs and interventions of mental health services should be continuous and supportive.