As Nancy Andreasen notes in the foreward to Psychiatric
Illness in Women, historically research into the treatment or natural
history of diseases has usually involved men, the "typical" patient
physicians were taught to interview or treat was male and pharmacological
treatments took a "one size fits all" approach. Modern medicine is progressively
acknowledging the need for idiosyncratic approaches to healthcare and the
management of illness, both pharmacological, as evidenced in the advent of
pharmacogenetics, and other.
Psychiatric Illness in Women provides an overview of the
current understanding of sex differences in the onset, presentation, course and
treatment of mental illnesses. The text concerns itself with the primary
psychiatric illnesses: anxiety disorders, depressive disorders, Schizophrenia,
dementia and their respective related disorders. Additional topics are included on PTSD; substance use disorders;
dissociative disorders; serotonin neuronal function in anorexia and bulimia
nervosa; pharmacological management of psychiatric illness in pregnancy; and:
women, ethnicity and psychopharmacology.
Overall, I found the book to be an excellent resource for
clinicians and researchers alike. For
clinicians, as just one example of its utility, chapter 24 on the
pharmacological management of psychiatric illness during pregnancy provides a
review of studies of teratogenic risk, long-term neurobehavioural sequelae and
direct neonatal toxicity of the psychotropic medications, along with treatment
guidelines for use of these drugs in pregnancy. The sex specific differences that are outlined (for example, in
chapter 20 on the effects of victimisation and PTSD on substance use disorders
and in chapter 19 concerning caregiver burden and stress and coping mechanisms
in female caregivers in Alzheimer's Disease) also provide excellent starting
blocks for more ecologically valid approaches to the non-pharmacological
management of psychiatric illness in women, for example, in terms of designing
interventions and determining the appropriateness of those selected.
In addition, chapters end with a conclusion that summarises
gaps in existing knowledge or any points of contention in the evidence base,
and some chapters even go so far as to include 'need for future research'
summaries (e.g. chapter 1 on sex differences in anxiety disorders).
Furthermore, some chapters provide both excellent reviews of a given area along
with details of the methodological shortcomings of research in that field, for
instance, the chapter by Hoff and Kremen on sex differences in neurocognitive
function in schizophrenia. Cumulatively, for researchers, an excellent starting
point is therefore provided for designing research that can both contribute to
the evidence base for psychiatric illness, and avoid shortcomings of design
that weaken its representativeness to the populations of interest.
My only criticism of the book, and it is a minor one, is
that some of the sections, particularly the one on schizophrenia, include
chapters on seemingly discrete topics that in reality have some overlap in
content. As a book apparently aimed at
providing a summary of current knowledge on sex differences in psychiatric
illness, this can be problematic, as different authors will evidently draw on
different evidence bases or aspects of these evidence bases, and may draw
different interpretations or arrive at different conclusions from studies,
which overall can lessen the usefulness of the book as a reference guide.
However, aside from this one point, the book is a
fascinating read, and accessible to a range of audiences, lay and professional
© 2003 Yvonne Melia
Melia writes about herself:
I have a
first degree in Applied Psychology, with a Postgraduate Diploma in Clinical
Neuroscience and am presently employed as Research Associate for the UK Brain
Injury Rehabilitation Trust.