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Major depression, anxiety disorders, and other specific disorders are common and therefore are seen in general gynecologic practice.
Appropriate referral to mental health specialists must be made in a sensitive manner.
Suicidal and homicidal behaviors are absolute indications for referral.
Alcohol and other substance abuse needs prompt recognition and intervention.
Some women are vulnerable to mood symptoms at times of hormonal change. However, menopausal hormone levels are not correlated with depression, and premenstrual syndrome should not be diagnosed without 2 months of prospective daily ratings.
Personality disorders and somatizing disorders rarely can be cured, but informed management can greatly decrease the suffering of the patient
Withdrawal of successful psychotropic treatment is very likely to lead to relapse.
Psychotic disorders should nearly always be managed by psychiatrists.
Psychiatric problems are a central or complicating factor for many patients who seek care on an outpatient basis (1,2). Psychiatric diagnoses are extremely common and account for considerable morbidity and mortality in the general population (3). Despite their prevalence, psychiatric disorders are often undiagnosed or misdiagnosed (4–7). Clinical depression affects up to one-fourth of women during their lives, but probably more than half of those women are neither diagnosed nor treated (8–11). More than half of the patients who commit suicide have seen a nonpsychiatric physician during the previous 3 months (12).
Psychiatry in the Gynecology Office
Many gynecologists feel uncomfortable diagnosing and treating psychiatric illnesses. The practice of gynecology is demanding, and patients with psychological problems can evoke a variety of negative reactions in physicians (Table 12.1). Some physicians, and some members of the public, have the misconception that psychiatric diagnoses are vague and ill-defined. Current diagnostic criteria and categories of psychiatric disorders are supported by empirical evidence
Table 12.1 Practitioners’ Negative Reactions Toward Patients with Psychiatric Problems 1.
Social stigma attached to psychiatric diagnoses, patients, and practitioners.
2.
Belief that individuals with psychiatric disorders are weak, unmotivated, manipulative, or defective.
3.
Belief that the criteria for psychiatric diagnoses are intuitive rather than empirical.
4.
Belief that psychiatric treatments are ineffective and unsupported by medical evidence.
5.
Fear that patients with psychiatric problems will demand and consume inordinate and limitless time from a medical practice.
6.
Precipitation in others, including doctors, of feelings that are complementary to the strong and unpleasant emotions experienced by patients with psychiatric disorders.
7.
Gynecologists’ own uncertainty about their skills at psychiatric diagnosis, referral, and treatment.
8.