Reproductive Psychiatry
Reproductive psychiatry aims to diagnosis and treat psychiatric disorders that may be related to a woman's reproductive cycle, including the menstrual cycle, pregnancy, and menopause.
For most women, physical and emotional symptoms of PMS such as abdominal bloating, breast tenderness, irritability, depressed mood, and difficulty concentrating, are manageable aspects of the menstrual cycle. But in 3-8% of women, these symptoms are so severe that they impair ability to function. This syndrome is called Premenstrual Dysphoric Disorder (PMDD). Many women with PMDD respond successfully to medications that have traditionally been used for depression.
Pregnancy can be a period of emotional well-being, but for some women it can be just the opposite: studies show that depression is one of the most common complications of pregnancy. Women with pre-existing psychiatric disorders are at particular risk of relapsing during pregnancy or postpartum. Family history of depression, poor social support, and unplanned or unwanted pregnancy are also risk factors for depression during pregnancy.
If you have already been treated for a psychiatric disorder or feel that you are at risk for developing one, a consultation with a psychiatrist who specializes in reproductive women's mental health can advise you about diagnosis and treatment both during and after your pregnancy. A psychiatrist can help you weigh the risk associated with medication treatment during pregnancy against the risk of untreated maternal psychiatric illness. For example, some medications are safer to use in pregnancy than others and a specialized psychiatrist can help review the data that are available. Psychotherapy may also be recommended.
The post-partum period (after pregnancy) is another time when women are vulnerable to depression and/or relapse of previous psychiatric illness. Although many women experience passing feelings of "baby blues" in the 3-14 days after giving birth, about 10 to 20 percent of women become clinically depressed during this period. A common symptom of post-partum depression is anxiety. Women may worry that they are not doing a good enough job in caring for the baby. These symptoms can worsen to the point of impairing a woman's ability to care for herself or the baby. A specially trained psychiatrist can help a woman manage these symptoms. In extreme cases, a woman may lose touch with reality, for example hearing voices or believing the baby would be better off dead. This is a psychiatric emergency and requires immediate treatment.
Breastfeeding while taking psychiatric medications is another area of specialty within reproductive psychiatry. A psychiatrist can review the data that are available regarding breastfeeding and psychotropic medication and help a woman make informed decisions regarding what is safest for her and her baby.
Finally, menopause marks another transition period within a woman's life. It is characterized by physical symptoms such as hot flashes, sleep disturbance, and vaginal changes. Some women also experience emotional symptoms. If these symptoms begin to impair a woman's life, a mental health specialist can provide diagnostic and treatment advice.
Please also see the section entitled "Fertility and Assisted Reproduction".
People who suffer from eating disorders have a persistent pattern of dysfunctional eating or dieting behavior. These patterns cause significant emotional, physical and interpersonal distress. There are several types of eating disorders:
- Anorexia nervosa is characterized by inability to maintain a minimally normal body weight, an intense fear of gaining weight, dissatisfaction with and distortion in the perception of body shape and size, and the absence of menstrual cycles.
- Bulimia nervosa is characterized by a long-term cycle of binge eating (eating a large amount of food in a discrete amount of time, with a sense of lack of control) and compensatory behaviors such as vomiting, using laxatives or excessive exercise, in order to compensate for the effects of binging.
- Like those who suffer from bulimia nervosa, people with binge eating disorder have recurrent episodes of binge eating associated with a loss of control. However, they do not compensate for their overeating with behaviors such as vomiting, using laxatives or excessive exercise.
- Negative body image refers to a distorted perception of one's body size and shape, and feeling uncomfortable, ashamed and self-conscious about one's body. People with negative body image have a greater likelihood of developing an eating disorder and are more likely to suffer from feelings of depression, isolation, low self-esteem and obsession with weight loss.
The goal of treatment is to address the symptoms of the eating disorder, as well as the underlying psychological, interpersonal, and cultural forces that contribute to it. Clients receive care within an inpatient or day treatment program, or as outpatients in individual, group or family therapy. Nutritional counseling provided by licensed professionals with an expertise in eating disorders may also be a component of treatment. The involvement of a primary care physician may be necessary to manage medical complications caused by the eating disorder. Psychiatric medication is also prescribed in some cases.