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This chapter on postpartum adaptation/baby blues describes the transient symptoms of sadness, tearfulness, irritability, and insomnia know as the “baby blues” experienced by 50% to 80% of new mothers. This is not a sign of depression but, rather, the consequences of the massive bio-psycho-social changes that occur after the birth of a child. No specific treatment other than education and reassurance is required. Most often these symptoms resolve spontaneously within the first 2 to 3 weeks. Occasionally, they continue and develop into a major depression so women should be reassessed within the first 6 weeks postpartum to ensure the symptoms have cleared.

Executive functioning generally refers to the ability to organize thought and action based on intentions and goals, especially in novel, complex or difficult situations. Executive functioning is a multifaceted psychological construct that may be depicted as a set of related but separable high-level cognitive abilities, possibly supported by the prefrontal cortex and implemented by larger brain networks (Miyake et al., 2000; Shallice and Burgess, 1996 but see Duncan et al., 1997). Many models exist that emphasize commonalities or differences among various executive functions (EF). While the number and type of EF that exist remain a topic of debate, most authors would agree that EF show high intra- and inter-individual variability in terms of their cognitive and behavioral manifestations.

Contrary to widely held beliefs, menopause is not associated with an increase in psychiatric illness. Although just prior to menopause there is a slight increase in minor psychological symptoms, prevalence rates of depression fall post-menopause. Hypotheses for the occurrence of depression in some perimenopausal women include: a pre-existing sensitivity to the change in the gonadal hormones leading to decreases in neural transmitters; reactions to the physiological changes associated with menopause such as night sweats; or the influence of a multitude of negative attitudes and expectations concerning menopause. The loss of the protective effects of estrogen may be related to the slight increase in the incidence of schizophrenia in women at menopause. The role of hormone replacement therapy (HRT) in treating psychiatric symptoms remains poorly understood. In nondepressed women, HRT may improve well-being either as a direct effect or as a consequence of reduced physical symptoms and fear of aging. In women with moderate to severe depressions, HRT alone does not appear to be beneficial. HRT may have some beneficial effects on short term memory. More research is needed to assess the possible role of HRT in augmenting the effects of antidepressant and antipsychotic medications.

Objective: This paper is the first of a 2-part review on the topic of stalking. It outlines the behaviours involved, epidemiology, motivation of offenders, and mental health consequences for the victim. Method: Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information. Results: Up to 1 in 20 women will be stalked during her lifetime. The majority of victims are female, while the offenders are usually male. Stalking behaviours range from surveillance to threatening aggressive or violent acts. The majority of stalking relates to failed intimate relationships. Stalkers may also suffer from erotomania or obsessional love with a primary psychiatric diagnosis. Victims may experience anxiety, depression, guilt, helplessness, and symptoms of posttraumatic stress disorder (PTSD). Conclusion: Stalking is a serious offence perpetrated by disturbed offenders. It can cause major mental health consequences, which are often poorly understood by society.

Objective: This paper is the second of 2 parts reviewing the topic of stalking. It focuses on victims' difficulties with the legal system and the psychotherapeutic tasks for victims and therapists. Method: Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information. Results: Victims suffer emotional consequences from being stalked. Additional stress is caused by the legal system's lack of understanding of the causes and consequences of stalking and inadequate and unenforced laws. The treatment of victims requires a comprehensive approach, including education, supportive psychotherapy, and discussion of practical measures. Therapists may over identify with the patient's powerlessness or hesitate to take on a case out of fear of the stalker. Female therapists may protect themselves against the realization of their own vulnerability by blaming the victim, while male therapists may feel defensive or overprotective. Conclusion: Stalking is a crime with major mental health consequences which is often poorly understood by society. Therapists need to be aware of the victim's emotional reactions, the types of legal and practical supports available, and the possible biases of society. Further education and research should be encouraged.

(1996). The Psychological Impact of Infertility and New Reproductive Technologies. Harvard Review of Psychiatry: Vol. 4, No. 3, pp. 168-172.

Thirty-nine women who had miscarriages completed questionnaires within 3 months, and at 6 months and 1 year following the miscarriage. Subjects completed the Centre for Epidemiological Study Depression Scale (CES-D), the Spanner Dyadic Adjustment Scale (DAS), the Rosenberg Self-Esteem Scale, the Maffcr Feminine Identity Scale and two study questionnaires. Miscarriage had a significant impact on most women's' lives over the year, regardless of their age or the presence of other living children. Depression scores were elevated at 3 months after miscarriage, decreased at 6 months and were again elevated for most women at I year. Women without other children had the highest depression scores at 3 months and 1 year. Depression scores increased widi desire for children and guilt about the loss. Measures of marital adjustment varied significandy over time but remained in the normal range. Femininity showed a trend to vary over time. Women who had more traditional views at 3 months after miscarriage were...

Objectives: In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD. Methods: MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included. Results: Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors. Conclusions: This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.

This article reviews the existing literature on the subject of patient-therapist sexual contact. Seven point one percent to 10.9% of male therapists and 1.9% to 3.5% of female therapists admit to engaging in intimate contact with patients. Offenders tend to justify their behaviour as being at least innocuous if not beneficial for the patients. The consequences to the patients include increased psychological and psychosomatic complaints, greater mistrust and anger towards men, hospitalization and suicide. Transference and countertransference issues which account for this behaviour are explored as is the issue of post-termination involvement. Education of physicians and residents concerning the temptations and dangers of this type of contact is strongly recommended.

Gender differences in depression have been documented for many years and thought to be insignificant to treatment selection until recently.This article reviews gender differences in the prevalence, presentation, etiology, and antidepressant treatment of depressive disorders.The high female to male sex ratio in the prevalence of depression, especially during the reproductive years, is one of the most replicated findings in epidemiology. Women more often have a seasonal component, anxious and atypical depression. Explanations for the differences include psychological, neurochemical, anatomic, hormonal, genetic, and personality factors. Gender differences in antidepressant treatment response have not been found consistently. Hormonal status may be an important variable in addition to the effects of the menstrual cycle, pregnancy, perimenopause and menopause.Women have higher rates of depression and can often present differently than do men. Further research can ascertain which combination of factors increase women's risk. The effect of pregnancy and the impact of the menstrual cycle on the course of all depressive disorders need increased attention. Large prospective randomized controlled trials with gender differences in treatment response as the primary endpoint are necessary in order to answer the now controversial question of gender differences in antidepressant treatment response.

We review current data on types of stressors acting on women physicians, the consequences of these stressors and methods of coping with them. We undertook a systematic review of original articles published in the last 15 years and registered mainly on Medline and on the internet websites focusing on these issues. In addition to the pressures acting on all physicians, women physicians face specific stressors related to discrimination, lack of role models and support, role strain, and overload. The depression rate in women physicians does not vary from that of the general public but the rates of successful suicide and divorce are much higher. Women in academic settings are promoted more slowly, have lower salaries, receive fewer resources, and suffer from a range of micro-inequities. They often lack mentors to provide advice and guidance. They must cope with the pressures of choosing when to have a child and conflicts between being a wife and mother and having a career. Despite these pressures, they report a high degree of career satisfaction. Although women physicians suffer from a variety of stressors that can lead to career impediments, stress reactions, and psychiatric problems, generally they are satisfied with their careers. Personal coping techniques can help women deal with these stressors. Pressures will continue until attitudes and practices change in institutional settings. Some institutions are initiating changes to end discrimination against women faculty.

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 victim's 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 victim's 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 person's ability to work through the many adverse emotional consequences suffered.

Objective: The study's objective was to determine the quality and severity of grief after spontaneous abortion and to statistically determine the effect of significant demographics and social variables such as age, number of previous losses and the effect of perceived family support on the grief experienced. Methods: Two hundred and ninety-four women who had experienced a miscarriage within the last year were the participants. One hundred and seventy-five had miscarried three months prior to participation in the study; one hundred and nineteen had miscarried one year previously. Ninety-five percent of women approached consented to participate. Standardized psychometric tests and Likert Scales measured elements of grief such as depression, self-esteem, perceived guilt and stress at two time periods in the first year after loss. Results: Women in both time periods after miscarriage had mean depression scores in the “clinical risk for depression” or “in need of treatment” range, i.e., pharmacotherapy or psychotherapy. A majority of women showed negative emotions like self blame and stress. Younger women with multiple miscarriages showed more depression in the early time period after miscarriage than older women ( p < .05). However, at one year younger women had the least depression. Marital and family conflict correlated positively with depressive symptomatology ( p < .05). Conclusions: Women assessed in the first year after spontaneous abortion show grief characterized by perceived stress and high levels of depressive symptoms including self-blame. Marital or family problems increase emotional risk to a woman after miscarriage.

Numerous physical and psychological symptoms have been attributed to the hormonal changes of menopause. Symptoms have also been attributed to loss of fertility, redefining of roles, empty nest syndrome, loss of femininity, and changes of status. Cross-cultural studies allow researchers to examine the contribution of physiological, psychological, and sociocultural influences to the experience of menopausal symptoms. Such research is complicated by differences between cultures in the definition of menopause, reproductive histories, symptom expression, and beliefs as to what constitutes status. A review of five important cross-cultural studies indicates that there are enormous differences in the experience of menopause among women in the same culture and among cultures. Menopausal symptoms seem to be caused by a combination of physical changes, cultural influences, and individual perceptions and expectations.

Coleman presents her conclusions as ‘an unbiased, quantitative analysis of the best available evidence’ concerning the adverse mental health consequences of abortion.[1][1] Huge numbers of papers by respectable researchers that have not found negative mental health consequences are ignored

S anta Fe, New Mexico, is the site of the 24th Annual Scientific Meeting of the North American Society for Psychosocial Obstetrics and Gynecology (NASPOG), formerly the American Society for Psychosomatic Obstetrics and Gynecology (ASPOG). Dates are February 28March 3, 1996, at the LaFonda on the Plaza Hotel. NASPOG is an interdisciplinary group of specialists in the field of obstetrics and gynecology, psychiatry, psychology, nursing, social work, anthropology, and other related disciplines. The annual meeting of NASPOG serves as a forum for scientific and clinical discussions about the biopsychosocial aspects of women’s reproductive health. This is defined broadly to include psychological, biological, public health, sociocultural, ethical, and other aspects of sexual, reproductive, and couple and parenting behavior. Although the primary focus tends to be on women, the study of men is also important to the Society insofar as men are involved with women in these activities. The 1996 meeting has a special focus on teaching and education about women’s health to professionals in training, such as medical students, residents, and graduate students, as well as graduate physicians and the lay public. Presentation of new knowledge in such fields as premenstrual dysphoric disorder, postpartum depression, and genital pain syndromes will also take place. Presented here are ten abstracts selected by the Society as most notable. These and others will be presented at the 1996 meeting. For further information about NASPOG, or the 1996 annual meeting, write to Jane Jenkins, Administrative Director, NASPOG, 409 12th Street SW, Washington, DC 20024-2188; phone (202) 863-1648, fax (202) 554-0453.

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 woman's 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.

It is frequently assumed that becoming a mother is an essential step in the development of female identity. Although female hormones may increase a woman's readiness to care for an infant, there is no clear cut evidence of a hormonal basis for maternal feelings. A woman's 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.

Pregnancy is seen as a period of psychological maturation during which old conflicts related to sexuality, aggression, dependency, autonomy and motherhood are rekindled and old solutions reworked. Anxiety associated with these conflicts may threaten to overwhelm the pregnant woman's ability to cope in an adaptive fashion and may result in the denial of pregnancy as a defense. Denial and rationalization of symptoms and denial of pregnancy may result in inadequate behavioural responses at the time of childbirth, and may result in the death of the newborn. The denial may also extend to the patient's social network and may continue through the post-partum period. The strength of the denial may be so great as to thwart attempts at psychotherapeutic intervention.

We analyzed questionnaires filled out by 23 mothers with careers and rated them as to degrees of autonomy: 26% received a ‘1’ (least autonomous) rating, 39% a 2’, 22% a ‘3’ and 4% (1 person) received a “4’ (most autonomous). Psychoanalyst Dr. Elizabeth Zetzel (1) stated “The healthy woman should be able to combine successful marriage and motherhood with some sort of personal career.” It would seem that the woman who is most effective at doing so is one who is highly autonomous and, therefore, feels free to construct a non-traditional role for herself. Unfortunately, in our study, these women were very much in the minority. In keeping with our hypothesis, the mere fact that a woman is combining a career and family is not a guaranteed indicator that she is highly autonomous.

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 resident's and hospital's 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.