Gail Erlick Robinson

The rational use of psychotropic drugs in pregnancy and postpartum.

When a pregnant woman or nursing mother requires psychotropic medication, one must consider the effect of such medications on the fetus or baby. The authors review the evidence for teratogenic effects of such drugs given during pregnancy, toxic or withdrawal effects in the newborn and dangers to the breast-fed baby. Suggestions are made for judicious use of psychotropic drugs in pregnant or nursing women.

Denial of pregnancy and childbirth.

The authors report three cases of denial of pregnancy and childbirth. Although the information available in these cases is limited an attempt is made to formulate the psychodymanics with reference being made to both the literature on the psychology of pregnancy and neonaticide.

Controversies about the use of antidepressants in pregnancy.

Abstract There is controversy about the use of antidepressant medication during pregnancy. Decisions about their use are affected by understanding the risks of these medications causing pregnancy loss, congenital malformations, neonatal adaptation syndrome, persistent pulmonary hypertension of the newborn, autism spectrum disorder, or long-term neurocognitive deficits. Although some research has raised concerns about antidepressants causing harm to the fetus and neonate, other studies have disputed these findings or noted that any risks found do not exceed the risk of congenital problems found in 1% to 3% of neonates in the general population. Untreated depression during pregnancy can also cause harm from poor diet, substance abuse, suicidal behavior, or prematurity. Decisions about the use of antidepressants during pregnancy must be based on a risk-benefit analysis based on the best evidence of the risks of treating or not treating maternal depression.

Psychological adjustment to familial genetic risk assessment: differences in two longitudinal samples

Heritable cancer risk assessment is an increasingly common method of deriving valuable information relevant to deciding on appropriate screening regimens and preventive treatments. Assessments of heritable risk typically include familial-genetic evaluation, where analyses relate family pedigree to cancer risk, and DNA testing, where analyses indicate genetic mutations associated with cancer risk (e.g., BRCA1/BRCA2 mutations) or their absence. In this paper we report on the psychological responses of women given familial-genetic evaluations for ovarian cancer risk. The baseline and 6 to 12 follow-up assessments of an initial clinic-attending cohort of 65 women are compared with the baseline and 9 to 12 follow-up assessments of a second clinic-attending cohort of 60 women. Sizeable differences were found in the prevalence of clinically significant depression in these two physician or self-referred populations, as assessed by the Center for Epidemiological Studies Depression scale and in the mean scores. Hypotheses accounting for these differences are discussed.

Motivation for Motherhood and the Experience of Pregnancy

It is frequently assumed that becoming a mother is an essential step in the development of female identity. Although female hormones may increase a womans readiness to care for an infant, there is no clear cut evidence of a hormonal basis for maternal feelings. A womans desire to have and raise children is affected by cultural expectations and opportunities. Current analytical thinking, while viewing reproductive choice as being an important component of feminine identity, does not emphasize the necessity of having a child to feel feminine. Once pregnant, the woman works through issues related to body image, relationship with mother and husband, concerns for the fetus, fears about the future and her new vision of herself.

Infertility by choice or by nature.

Sexually active women have only recently had the ability to make a conscious decision to delay or refrain from bearing children. This is not only the result of the availability of effective contraceptive methods but also due to attitudinal changes in society and individuals. These reproductive choices may result, for some women, in conflict over the use of contraceptives, and the decision or timing of pregnancy. However, infertility imposed by nature in the form of inability to conceive, miscarriage or stillbirth removes the womans sense of control over this important aspect of her life and frequently results in severe distress. The psychological issues surrounding these reproductive choices and events are reviewed and discussed.

Dilemmas related to pregnancy loss.

Women who lose desired pregnancies by miscarriage, stillbirth, genetic termination, or unsuccessful in vitro fertilization are at risk of suffering from grief, anxiety, guilt, and self-blame that may even present in subsequent pregnancies. A review of the literature reveals the dilemmas about effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging viewing and holding the baby. This approach has been questioned as possibly causing persistent anxiety. Women who miscarry are currently encouraged to find ways to memorialize the lost fetus. Immediate crisis intervention and follow-up care should be available, recognizing that individual women may experience different reactions and their specific postloss needs must be assessed.

Combining motherhood with psychiatric training and practice.

Psychiatric residency or practice is difficult to combine with motherhood. The experiences of 82 women psychiatrists surveyed in the last year (47 residents and 35 staff doctors) are reviewed in a number of related areas — the difficulties of pregnancy, maternity leave, child rearing and the conflicts between motherhood and practicing psychiatry. Part-time residency is explored from both the residents and hospitals perspective. Suggestions to make practice or residency more compatible with child rearing are discussed. Other issues such as work-based day care, realistic tax credit for child care expenses, and the difficulties of obtaining reliable and good home help and child care are reviewed. There are numerous conflicts for women psychiatrists who work while their children are young and these problems need to be acknowledged and addressed by the profession. It is noteworthy that as well as a supportive spouse and good child care, the attitudes of colleagues and supervisors and the need for good role models were frequently cited as being critical to the success of combining a psychiatric career with motherhood. As more women enter the profession (approximately 50% of psychiatric residents in Canada are now female, and more than 50% of them plan to combine children with their profession at some stage of their career) the need to find creative and workable solutions to these problems becomes more pressing.

Problems in the Treatment of Premenstrual Syndrome

Three categories of treatments for premenstrual syndrome (PMS) have been proposed: those designed to correct the cause of the disorder; those designed for symptom relief; and those aimed at eliminating the menstrual cycle. Many of these recommendations are based on poor research with loose definitions of the disorder and uncontrolled open trials. This paper reviews the literature on treatment methods with emphasis on recent random, placebo controlled, double-blind studies. The most effective current management of PMS is a conservative one including accurate diagnosis, stress control, sensible levels of diet and exercise and perhaps the use of alprazolam in the premenstrual period. Other approaches such as the use of mefenamic acid and evening oil of primrose remain unproven. Progesterone has been proven uneffective. Further research is required into the value of antidepressant medication.

Occupational Effects of Stalking

Objective: This case report and discussion describe the psychiatric and social consequences of being a stalking victim, with particular focus on its impact on the victims occupation. Method: Data were gathered from the assessment and arbitration hearing of a female employee who lost her job while being stalked. Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Results: This case illustrates many of the common features of stalking. The female victim was harassed by a male after a failed intimate relationship. The victim suffered from depression, anxiety, guilt, shame, helplessness, humiliation, and posttraumatic stress disorder (PTSD). The stalking affected her psychological, interpersonal, and occupational functioning. Consequently, she was fired for poor work performance and poor attendance. Conclusion: Stalking may affect a victims ability to work in several ways. The criminal behaviours often interfere directly with work attendance or productivity and result in the workplace becoming an unsafe location. Further, stalking may indirectly affect a persons ability to work through the many adverse emotional consequences suffered.