Reproductive Rights and Women's Mental Health

Reproductive rights, including access to comprehensive reproductive health care, are essential to the well-being of women and society. The Dobbs decision of the US Supreme Court has greatly exacerbated the confusion, the stress, and the loss of services. Psychiatrists need to know and communicate the strong scientific evidence of the advantages of sex education, contraception, abortion, and bodily autonomy and to help patients process their feelings and make informed decisions about their own care.

Update on Reproductive Rights and Women's Mental Health

Reproductive rights are essential to the recognition/treatment of women as full-fledged human beings/citizens. Barriers to reproductive rights pose a grave danger to women's well-being. This article explores the origins of these barriers, their nature, and their impact on mental health. The most controversial relationship is between induced abortion and mental health. Barriers, misinformation, and coercion affecting contraceptive, abortion, and pregnancy care are an ongoing danger to women's mental health and the well-being of their families. Mental health professionals are best qualified, and have an obligation, to know the facts, apply them, and provide accurate information to protect women's health.

Menopause: social expectations, women's realities

The experience of menopause, and the ramifications of that experience for psychiatric treatment, is significantly shaped by social and historical context and by the implicit and explicit expectations they arouse in women. American society is heavily youth-oriented. Although in fact many women experience this time as one of liberation and self-actualization, society views them as bereft of their families and devoid of sexual interest. Their expectations for their social roles at this time of life may not comport with those of their children. The emphasis on hormone treatment, incorrectly termed "replacement," has exacerbated women's fears of aging.

Psychiatric issues related to infertility, reproductive technologies, and abortion

Infertility, treatment with reproductive technologies, and abortion are among the most emotionally weighty and philosophically contentious experiences in most patients' lives. They involve the most intimate body parts and behaviors and the most heartfelt hopes and profound disappointments. They can strain relationships with partners, relatives, and friends. The primary care practitioner who is informed about the psychological impact of these experiences can play an essential role in interpreting medical information; helping patients think through their own values, resources, and options; facilitating communication between members of a couple and with their friends and family; providing emotional support; and identifying and treating psychiatric disorders that sometimes occur before, during, or after these experiences.

When your patient needs mental health care

Whether as primary care, specialty, or subspecialty physicians, obstetrician/gynecologists encounter many patients with mental health problems. Although fortunately, the stigma of mental illnesses and treatments has somewhat decreased and the accuracy of diagnosis and efficacy of care have increased, it has unfortunately become more complicated for patients to access that care. There are more and more mental health practitioners and disciplines, making it difficult for the referring ob/gyn and the patient to identify which sort of professional they need. There is an increasing array of third-party payer arrangements, each of which has constantly changing rules and procedures. This article illustrates some typical cases and summarizes some commonsense approaches. Its purpose is to help the busy practitioner connect patients with the care they need.

Depression in women

Depression is a common and serious psychiatric disorder, more common in women than in men. It can be triggered by abrupt hormonal changes, life events, or nothing at all. It causes enormous debility and significant mortality, and it costs the American economy hundreds of millions of dollars a year. Depression can be readily diagnosed and treated, but, more often than not, it is neither diagnosed nor effectively treated in the primary care setting. The stigma of mental illness and misconceptions about depression in particular, hinder recognition. The signs and symptoms of clinical depression as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, are valid and reliable. Both psychotherapeutic and psychopharmacologic treatments are effective. The obstetrician/gynecologist plays a crucial role in identifying depression, helping the patient, and sometimes her family, to understand the nature of the problem, suggesting treatment, and facilitating either referral or treatment within the Ob-Gyn setting.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians

LEARNING OBJECTIVES

After completion of this article, the reader will be able to understand the stigmata and misconceptions associated with a depression, to be aware of the various etiologies of depression and typical and atypical presentations, as well as the various management strategies for depression, and have a better understanding of which patients should be referred.

Psychiatry, the law, and public affairs

The law is a public affair. The involvement of psychiatrists and psychiatry in legal and judicial proceedings themselves, not to mention the ever-increasing media commentary, is an opportunity to educate the public, but it also entails the very real risk of compounding public misinformation and misgivings about our field. The American Psychiatric Association has both a professional staff Division of Public Affairs and a membership component, the Joint Commission on Public Affairs. Staff and members field queries from the public and the media, plan educational campaigns in collaboration with advocacy organizations, prepare and distribute fact sheets, media kits, and issue kits for members, brochures for the lay reader, booklets for important audiences including clergy, educators, and legislators, and many other resources. Given their critical influence on the lay-person's image and understanding of psychiatry, the participation of forensic psychiatrists in the public affairs activities of our major professional organization is not only welcome, but vital.

Conceptions and misconceptions. Decisions about pregnancy

Induced abortion has been practiced in every known society and in every era of history. Psychological concomitants of abortion are as much a product of the social and interpersonal context as of the process itself. Though abortion results in the loss of a potential human life, it is not associated with significant psychiatric morbidity, and, in fact, represents for many women--and men--a significant milestone in which they assume responsibility for the direction of their lives for the first time. However, assertions that abortion is psychologically damaging have characterized much of the recent bitter debate over the legality and availability of abortion. It is important that mental health professionals are knowledgeable about the subject of abortion so that they can discuss policy with their patients.

Contemporary issues in obstetrics and gynecology for the consultation-liaison psychiatrist

Medical advances in obstetrics and gynecology, combined with the depersonalization of health care and changes in sexual and reproductive behaviors in the general population, lead to challenging new problems for the psychiatric consultant who deals with reproductive issues. The author describes contemporary issues encountered in consultation-liaison work with the obstetrics and gynecology service in a general hospital. They include the reproductive implications of medical illnesses, the stress of deciding whether to continue a pregnancy known to carry genetic risk, the intrusiveness of certain options for dealing with infertility, parental expectations for a perfect baby, and the difficulties some traditional practitioners have in adapting their practice styles to the changing needs of the patient population.

Three cases of female anorgasmia associated with MAOIs

Monoamine oxidase inhibitors have been associated with male retarded ejaculation and impotence. The authors describe three cases of female anorgasmia secondary to this class of antidepressants. To the author's knowledge only one incidental finding of this kind has been reported.

How to write a psychiatric consultation

The written psychiatric consultation is the distillation, the official permanent record, and the one universal element of the consultation process. Both the document and process present a good and growing opportunity for service and teaching. The authors offer a conceptual and practical scheme to help potential consultants make decisions about the content, style, and wording of their written communications. Each of the components of the consultation document, including headings, openings, history, examination, and formulations, is considered in terms of its effects on the liaison with the consultee and the care of the patient.