Psychiatric disorders through the woman‘s lifespan

Psychiatric disorders have a tremendous potential to impact the lives of women. Although there has been a dramatic expansion of the treatment options for psychiatric conditions in the past several decades, these disorders often remain unrecognized and untreated. This issue of the International Review of Psychiatry will focus on conditions of particular importance to women, of periods when the diagnosis or treatment of psychiatric disorders is complicated by other factors such as during pregnancy. While the exact mechanism is not understood, periods of hormonal variation such as the premenstrual period, pregnancy and the postpartum period are all times of risk for mood and other psychiatric disorders. With estimates that up to 20% of women will have an episode of major depression in their lifetime (Kessler et al., 1994), it is critical that physicians understand the clinical presentations of the psychiatric illnesses with significant prevalence in women. With adolescence young women have a risk of growing preoccupation and dissatisfaction with their bodies. A combination of factors including the media, peer pressure and genetics is contributing to the increasing incidence and prevalence of eating disorders. In their review, Klein & Walsh focus on the epidemiology, potential risk factors, clinical features and treatment for the two major eating disorders, anorexia nervosa and bulimia nervosa. There are an overwhelming number of women compared to men suffering from eating disorders. As these disorders have very high rates of associated morbidity and mortality, early recognition and treatment is critical. These disorders also have high rates of comorbidity, particularly with mood, anxiety, and substance abuse disorders. A comprehensive understanding of the potential interactions with other conditions reviewed in this issue is important for treatment to be successful. During pregnancy the diagnosis and treatment of many medical conditions is complicated by concerns about teratogenicity. In their comprehensive review of psychiatric disorders during pregnancy, Cott & Wisner examine the expanding literature on the use of psychotropic medications during pregnancy. In addition to a systematic review of the most prevalent psychiatric disorders affecting women during pregnancy, Cott & Wisner stress the importance of ‘frank risk-benefit discussions’ between physicians and their patients. These discussions must include an assessment of the risks of treatment versus the risks of not treating these conditions. The complexity of treatment is not limited to pregnancy. During the postpartum period most women experience mood symptoms. The challenge for clinicians is to distinguish the self-limited ‘baby blues’ from more serious symptoms of postpartum depression and psychosis. Seyfried & Marcus outline the clinical presentations and treatment strategies for each category of postpartum mood disorder. As new mothers face a variety of challenges, their changes in mood, sleep and energy are often understood as an expected part of having a new infant. This bias further complicates the early detection and treatment of postpartum mood disorders. Women are often reluctant to pursue treatment for their postpartum illness due to concerns about beginning medications while breast-feeding. This instinct to protect their children must be put in a context for mothers. The development of a child may be significantly impacted by maternal depression. Discussions of treatment options in mothers should include the potential risk to their children of their not receiving treatment and remaining depressed. In her paper, Burke reviews the issue of maternal depression and its impact on children and partners. She also discusses the risk for postpartum depression in fathers. The lack of hormonal factors in men suggests that postpartum depression in women is likely a complex combination of hormonal factors and biological vulnerability to stressful life events. The next review addresses the issues unique to alcohol misuse in women. While of lesser prevalence