Volume 4 Issue 9 Sept 2014
“A woman is the full circle. Within her is the power to create, nurture and transform.” (Anonymous)
So much said about women’s strength, the question to be answered is ‘Are psychological issues of the female less important than males?’ The Answer is ‘NO’. Various hormonal changes taking place in female’s body starting from menarche to menopause, leads to increased susceptibility to certain psychiatric morbidities in them. Additional problems like gender bias, female infanticide or abandonment and sexual abuse adds up to their agony. Low literacy rate, poor consideration of health care for females ultimately can lead to their disturbed mental health.
Apart from common psychiatric problems in both genders, certain specific illnesses related to females are:
Premenstrual dysphoric disorder (PMDD)—75% of the women in reproductive age group experience some or the other PMDD symptoms and 3—8% suffer from severe symptoms. The PMDD symptoms comprise of mild swelling, bloating, irritability, poor concentration, disturbed sleep and appetite, dysphoria etc. Treatment consists of diet, exercise, stress reduction, relaxation etc. Pharmacotherapy with vit. B6, Calcium, Iron supplements, and SSRIs (commonly used is Fluoxetine) etc.
Infertility– Even though, infertility can have aetiology in both the partners, woman receives maximum criticism for either not conceiving or not having a male child. Psychological stress can be cause as well as consequences of infertility. Infertile woman can develop depression, anxiety, anger, hostility and frustration. Some studies have found suicidal ideation in 50%, dysthymia in 18%, depression in 15% and anxiety in 6-7% of infertile women. Management consists of antidepressants, counselling to improve coping mechanisms.
During ante-partum period, there is increased risk of depression and anxiety resulting from many factors like wanted or unwanted pregnancy, marital discord, poor psychosocial support and family history of depression.
In post partum period, post-partum blues occurs in 50-80% of women and major depression in 10-15% of them. Symptoms include depressed mood, irritability, loss of interest, insomnia, poor appetite, fatigue, suicidal ideas etc. Management is with anti-depressants, anti-anxiety drugs and counselling or CBT.
Post-partum psychosis occurs in 1-2/1000 cases. Symptoms include restlessness, irritability, mood fluctuation, sleep disturbances, hallucinations, delusions etc. Management consists of anti-psychotic drugs and/or ECT and isolation of mother and baby or supervised contact to prevent harm to the baby.
Perimenopausal syndrome is because of disturbances in FSH, LH and Oestrogen and can occur 2-8 years before or 1 year after menopause. Depression is seen in 33 to 48% of cases. Symptoms like hot flushes, sleep disturbances, somatic symptoms, depressed mood, persecutory delusions etc are commonly observed. Management is in the form of anti-depressant drugs, hormone replacement therapy and counselling.
Considering other common psychiatric illnesses, women carry different prevalence, course and prognosis as follows: Schizophrenia—Females have late onset illness, more positive symptoms, less changes in the brain, good prognosis (due to protective effect of female hormones) and requires low doses of anti-psychotics as well as less chances of anti psychotic related extra pyramidal symptoms. Prevalence of depression is more in females. Prevalence of bipolar disorders is equal in both gender however, females have more episodes of depression, mixed states and rapid cycling. All anxiety disorders have higher prevalence in females except OCD which is equally found in both the gender. Substance abuse is less in women but if present has higher co-morbidity of other psychiatric disorders. Eating disorders are more common in females. Problems related to sexual, physical abuse in females are on rise and can have detrimental effects on their psychological health.
Considering this background, a psychiatrist or any other health professional shall be aware of various psychological problems in females so as to address them timely and help them to maintain their strength!
Hon. Professor, Former HOD, Department of Psychiatry,
K.J. Somaiya Medical College & Hospital, Mumbai.
