Can schizophrenia be inherited from mother to child?

Question

Hello doctor,

I am writing about my 28-year-old daughter, who was diagnosed with schizophrenia two years ago, and I am really struggling to help her. She started hearing voices during her last year of college and had a complete breakdown where she thought people were trying to poison her food. The psychiatrist has her on Risperidone 4 mg twice daily, but she has gained 45 pounds since starting it and now weighs 215 pounds. Her prolactin levels are really high at 98, which has caused her periods to stop completely for the past eight months. She also has milk coming from her breasts even though she has never been pregnant, and it is really embarrassing for her. She tried switching to aripiprazole, but she had terrible akathisia, where she could not sit still and had to pace around all day.

The schizophrenia seems more stable now, but she has developed prediabetes with a fasting glucose of 118, and her cholesterol is high too. She has been in a relationship with a nice guy for the past year, and they want to get married, but I am scared about her having children with this illness. Can schizophrenia be passed to babies? Also worried about pregnancy because I read the medications can cause birth defects. She sees a therapist weekly but still has days when she believes the voices are real. What are safer medication options that would not cause so much weight gain and hormone problems?

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

It must be difficult for you to take care of your daughter. It is common to gain weight and raise prolactin with Risperidone. You need to switch to another medication, such as Ziprasidone. It causes less akathisia, and the dose should be gradually increased. Managing akathisia is easy compared to other side effects such as weight gain, prolactin, and diabetes. Therefore, combine Propranolol along with Ziprasidone low dose to avoid developing akathisia.

Yes, no antipsychotic is safe in pregnancy, but the risk of recurrence and severity rises multiple times during pregnancy.

Therefore, continue medications even if there is a pregnancy, as no congenital malformations are reported. Risk of relapse increases multiple times during pregnancy; therefore, in risk-benefit analysis, always continue medicines.

There is another myth that psychotic patients cannot marry; they can and live a good life, as schizophrenia is a manageable condition. Lifestyle modifications are also very important, such as brisk walking, a low-carb and fat diet, and reducing sugar and caffeine. Augment it with a medication switch. CBT (cognitive behavioral therapy) in psychosis is another option; it is an effective and evidence-based therapy.

It can be considered in your daughter's case, as her acute symptoms have been resolved. Other medication options, such as metformin, are also good to reduce weight. You can also choose ECT (electroconvulsive therapy), which is not only safe but also very effective. There is a myth associated with it, but it is also a very good option. Many of the patients choose this option as well. Please let me know how the Ziprasidone switch goes.

I hope this information will help you.

Thanks.