Because psychiatric problems frequently present in gynecologic practice, it is worthwhile for the gynecologist to develop an ongoing relationship with one or more local mental health professionals. The state psychiatric society may have a list of subspecialists in “consultation liaison” psychiatry; this is an official subspecialty of the American Board of Psychiatry and Neurology. Many psychiatrists without specific fellowship training offer consultative services. The availability of familiar and trusted resources enhances the likelihood that problems will be identified and addressed. An ongoing relationship with a mental health professional allows the gynecologist to familiarize that professional with relevant developments in gynecology. It is important to keep up-to-date information on local suicide prevention hotlines and other kinds of resources for battered women and for mothers who may pose a danger to their children. Local laws may require that physicians report to the authorities their knowledge of mothers in this situation (19).
Whenever a patient’s thinking, emotions, or behaviors cause concern, the gynecologist should first consider a nonpsychiatric medical disorder or a reaction to prescribed or illicit drugs. Psychiatric disorders frequently coexist with these conditions (19). HIV/AIDS infection, some malignancies, hypothyroidism, and other diseases can present with psychiatric symptoms.
Psychiatric conditions are extremely common in gynecologic practice. Some are primary and some are related to reproductive events. All patients should be screened for depression, anxiety, domestic violence, and substance abuse, each of which can be diagnosed and treated, either by the gynecologist or by referral to a social resource or a mental health specialist (16–19).
Mood is the emotional coloration of a person’s experience. Mood may be pathologically elevated (mania) or lowered (depression) or may alternate between the two (bipolar or manic-depressive disorder) (26). Mood disorders are different from, but frequently confused with, the inevitable ups and downs of everyday life, such as the reactions to difficult situations, including gynecologic conditions. In the English language, depression is used to describe both a transient mood and a psychiatric disorder. Because of this confusion, both patients and their loved ones become frustrated when well-meaning attempts to reason with them, distract them, or do thoughtful things for them in a manner that would affect a self-limited reaction to a difficult situation, fail to inﬂuence their protractedly disturbed moods.
Mania is characterized by the following behavior (26): 1.
Elevated mood, with euphoria or without irritability 2.
3.
Pressured, accelerated speech and physical activity 4.
5.
6.
Reckless and potentially damaging behaviors, such as wild expenditures and promiscuity
Mania can be acute or subacute (hypomania). Hypomania can produce self-confidence, ebullience, energy, and productivity that are the envy of others, making the patient reluctant to relinquish this mood by undergoing treatment. It can be particularly difficult to arrest the condition before it progresses to full-blown mania. Acute mania is a life-threatening condition; without treatment, patients fail to maintain essential sleep and nutrition levels and literally exhaust themselves with frantic activity. Patients with bipolar illness must be taught and encouraged, and often learn from bitter experience, to recognize the early signs of disturbed mood so that treatment or treatment changes can be initiated (16).
The overall lifetime prevalence of affective disorders is 8.3%; the 6-month prevalence is 5.8%.
During the reproductive years, depression is two to three times more common in women than in men (26–32). The highest incidence of depression is in the age group of 25 to 44 years, but depression occurs in every age group, from toddlers to the aged. Women have a lifetime risk of 10% to 25% and a point prevalence of 5% to 9% (33–36). Although public understanding and acceptance of mental illnesses has significantly increased, patients may have difficulty accepting, and telling others, that they are suffering from depression.