In recent decades the relationship between childbirth and psychiatric disorders has come to greater prominence with postnatal (post-partum) depression becoming a generally recognised, if clinically imprecise, term. This has brought undoubted benefits in the fight for services and in reducing stigma for women with mood disorders at this time. A focus on postnatal depression, however, has not been without problems. First, the range of important disorders occurring in relationship to childbirth is far greater than non-psychotic episodes of depression – the weight of evidence suggests that bipolarity has a specific relationship to the post-partum period for example. Second, a focus on the post-partum period has diverted attention from the importance of psychiatric disorders that occur in pregnancy, an issue which is addressed in this book.
Psychiatric Disorders and Pregnancy sets out to redress the balance and covers a wide range of areas – from screening for risk of severe post-partum illness, through specific conditions (including mood disorders, psychosis, eating disorders, personality disorders, post-traumatic stress disorder and substance use disorders) to specific modes of treatment and models of healthcare. Although focused on pregnancy, many chapters also deal with the postnatal period. In addressing these issues the book is to be commended and there is much of interest here for both the specialist and the casual reader. In this respect I feel it is a real shame that the book has been priced at £75, putting it beyond the reach of anybody but the most committed perinatal specialist and libraries.
The predominantly British authors include many well-recognised experts in their fields and a number of chapters are of particular interest and would reward revisiting. As with any multi-author book covering a specific area there is some repetition, and there is always the danger that advice regarding the safety of medications during pregnancy and breast-feeding is quickly out of date – recent data on paroxetine, for example, were clearly only available after publication deadlines.
Although I agree with the editors that mood disorders during pregnancy have been neglected in clinical practice and research, I believe it remains to be demonstrated that this is a period of higher risk for episodes of major depression compared with the post-partum period (as opposed to depressive symptoms more generally). In this area as in others, more research is clearly needed. In fact, the abiding impression I have from reading this book is the exciting opportunities that exist to further research on psychiatric disorders in relation to pregnancy. If this book goes someway to highlight the areas where work needs to be done, then it has served an important function. I just wish it were cheaper.
- © 2007 Royal College of Psychiatrists