Psychiatric Disorders in Women over the Life Cycle Flashcards
Two disorders with > 4:1 F:M psychiatric diagnoses
- anorexia
2. bulimia
Five 2:1 F:M psychiatric diagnoses
- MDD
- panic disorder
- agoraphobia, specific phobia
- Generalized Anxiety Disorder
- PTSD
NOT OCD OR SOCIAL PHOBIA
Three reasons why is MDD more common is women?
- Psychosocial factors
- Reproductive events
- biological vulnerability
What are some psychosocial factors that contribute to the higher prevalence of MDD in women?
gender-based violence: rape, sexual abuse, domestic violence), socioeconomic status, multiple roles, caregiving responsibilities
What are reproductive events that contribute to the higher prevalence of MDD in women?
menstrual cycle, infertility, pregnancy, postpartum period (increased risk of psych admission immediately postpartum), menopausal transition/perimenopause, hormone therapies
Why are women biologically vulnerable in respect to MDD?
higher incidence of MDD from puberty to menopause, most suicide attempt admissions during early follicular/late luteal/decreased estrogen (in general, estrogen –> increased serotonin and progesterone –> decreased serotonin)
One F > M disorder:
bipolar II
4 F < M disorders:
substance abuse, antisocial personality disorder (PD), narcissistic PD, obsessive compulsive PD
differences in clinical presentation of bipolar disorder in women:
more mixed episodes more depressive episodes, rapid cycling, later age of onset.
differences in clinical presentation of schizophrenia in women
later age of onset (25-35), higher premorbid and social functioning, more “benign” course
Pre-menstrual Dysphoric Disorder (PMDD): prevalence
3-8% of menstruating women
clinical presentation of PMDD:
onset of sx during the luteal phase with resolution by menses onset (no sx during follicular phase), very severe sx, mood > physical sx, >=5sx in most cycles with marked impairment in social/occupational functioning
Mood sx of PMDD:
depression, anger/irritability, affective lability, anxiety, sensitivity to rejection, , poor concentration, sense of feeling overwhelmed, social withdrawal
physical sx of PMDD:
lethargy/fatigue, sleep disturbance (usually hypersomnia), appetite disturbance (usually increased), abdominal bloating, breast tenderness, muscle aches/joint pain, swelling of extremities,
Treatment of PMDD:
- Lifestyle interventions
- SSRIs: fluoxetine, paroxetine, sertraline: immediate effect
- Yaz OCP (if also being used for contraception)
lifestyle interventions effective in treating PMDD:
exercise, chasteberry herbal remedy, calcium, vit B6, magnesium, vitamin E
How is PMDD different from pre-menstrual syndrome (PMS)?
In PMS, more physical than mood sx. PMS is not in the DSM.
What are the risk factors for depression in pregnancy?
History of depression, poor overall health, greater alcohol use, smoking, unemployment, lower education level, not married
Is the prevalence of mood disorders in pregnancy less than, the same as, or greater than that in the general population?
The same (10-15%)!
However, there is a very high relapse rate (50-70%) of mood disorders in women who are treated with antidepressants that need to be terminated for pregnancy.
Exception: for bipolar disorder, the relapse rate is the same as the general population.
Treatment of depression in pregnancy:
- Psychotherapy
- light therapy
- ECT, TME
- omega-3-fatty acids
- psychosocial support
- LIMITED psychotropic meds (MINIMIZE!)
Are SSRIs safe during pregnancy?
We don’t know. Mixed data regarding teratogenesis. However, Risk of untreated depression and anxiety in pregnancy IS A KNOWN RISK.
risk of untreated depression and anxiety in pregnancy?
increased suffering, decreased ability to care for herself/baby, increased risk pre-term delivery, preeclampsia and low birth rate (perhaps due to increased cortisol), increased substance/alcohol/cigarette use, increased risk of postpartum depression.
Is post-partum “baby blues” normal?
normal if it’s not persistent (< 2weeks) and non-impairing
post-partum psychosis: clinical presentation
onset 24hours-3weeks post-partum: rapid mood swings, insomnia, obsessive thoughts, delusions (commonly involving infant), hallucinations, impaired reality testing, shifting mental status/disorientation/confusion/disorganized behavior, high rate of suicide and infanticide if untreated!!
