V O'Keane, M Marsh, G Seneviratne, editors. Psychiatric Disorders and Pregnancy. 326 pages, tables. London and New York: Taylor & Francis, 2006. ISBN 1-84184-462-4. Price GBP 75.00. This book is a rare example of a “new” monograph, in the sense that mental health during and after pregnancy to my knowledge has never before been dealt with between two covers. The three editors and eighteen others cover the subject from every possible angle, from mood changes and minor depression to severe psychiatric illnesses that affect mother and offspring before, during, and after birth. Interestingly, Editor Michael Marsh is the only author who appears to be academically affiliated with obstetrics and gynecology, as judged from the list of contributors. Most of them come from the UK, two from the USA, and one, Klaas Wijma, from Sweden. From the Scandinavian point of view, I note that in several chapters the authors draw heavily on references from the Nordic countries. To the obstetrical mind, severe postpartum depression has been the dreaded condition. Here we learn that in most cases it is preceded by depression during pregnancy, often not recognized in the busy antenatal care clinics. Although a rare tragedy, suicide is presently the leading cause of maternal death in the UK. For this and other reasons, screening for symptoms of depression has been put into practice in many maternity services in the UK. Of course, a clear-cut definition of depression is difficult, which makes studies of its aftermath all the more difficult to interpret. Pre-term birth has been suspected, but strong evidence for a significant correlation is lacking. Chapters on mentally ill mothers and their babies, and infanticide and child abuse with case examples are instructive. These are followed by “Management of psychosis before, during and after pregnancy”, with separate headings for bipolar affective disorder and schizophrenia. Eating disorders are next on the list; these seem to be increasingly common. People with personality disorders were in my student days lumped together as psychopaths. That term is extinct because of the stigma attached to it. Those who answer to the definition are now separated into three broad clusters, within each of which you should be able to identify three or four subclusters of abnormal personalities, if you follow the diagnostic pathways carefully. I tended to get lost in the maze. Klaas Wijma describes post-traumatic stress disorder in eight instructive pages, then goes on to the specifics on post-traumatic stress disorder in the obstetrical context. Substance use disorders in pregnancy are well covered in the next chapter, appropriately followed by teratogenicity and psychotropic use during pregnancy and a separate chapter on breastfeeding and drugs. The book is rounded off with psychological therapies, (British) models of health care in the management of women with psychiatric disorders in pregnancy, and finally the effects of stress and psychological management at term and during labor. Most if not all of the chapters contain descriptive compilations of recent publications, and the lists of references accordingly appear to be comprehensive. Each chapter ends with a topical and useful discussion of management during pregnancy and puerperium. Meta-analyses in the ordinary sense are notably absent, as evidence-based results in the field of mental health and pregnancy are largely lacking, whether in risk factor analyses or in effects of the various treatment options. As drug treatment is an integral option in the management of almost every mental disorder, there is an inevitable overlapping of psychopharmacology throughout the book. Psychologists and psychiatrists do love to use words, and this book is no exception. Reading all through it in one session is a hard task. Nevertheless, there is a wealth of good information in all of the chapters, which ought to be perused separately. I recommend it as an excellent source of information to obstetricians and midwives. It should be available in every obstetrical department and antenatal care unit. I am confident that professionals in the mental health field will also find it useful.
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Apr 29, 2008
Takashi Ikegami + 7
Open Access