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Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale
Book Reviews cross- cultural,” accepting the uniqueness of each individual’s response to his/her illness and its treatment and helping the patient reach the decision that is best for him or her, whether it be about starting or continuing treatment or how to use added or restored years of health. In summary, both books have strengths. Shernoff and Smith’s book is a quick read that might be most useful for a beginning therapist in any discipline who doesn’t have a lot of HIV mental health experience, while Goldblum and Erickson’s work on bereavement can stand by itself, as both a brief reference on the topic in general as well as a state of the art primer on working with bereavement in the context of HIV. Dr. O’Dowd is Associate Professor of Psychiatry at Albert Einstein College of Medicine and Director of the Consultation-Liaison Psychiatry Service at Montefiore Medical Center.
Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale Edited by John Cox and Jeni Holden London, The Royal College of Psychiatrists 1994, $35.00 ISBN 0-902241-68-0, 275 pp Reviewed by Linda Worley, M.D.
P
erinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale will likely be a resource on the shelves of professionals in the field of perinatal psychiatry for years to come. This publication grew out of the collective efforts of leaders in the field attending the Marce Society and the Centre for Reproductive Psychological
446
Medicine Conference in Keele, England, October, 1991. The agenda for the meeting was “to discuss the increasing use of the Edinburgh Postnatal Depression Scale (EPDS) in the United Kingdom and overseas within the context of strategies for prevention.” The resulting information was published in an effort to extend knowledge in the field and to disseminate practical methods for helping women. Overall, this book is a very useful resource for planning perinatal psychiatry programs, with two limitations. The first limitation is that it was published in 1994, which dates specific treatment recommendations (only one chapter). The second limitation is that model treatment and prevention programs were based on the health care resources available in the United Kingdom, which are not readily transferable to the United States (where a very different medical/legal climate exists, with limited postpartum outreach programs). The authors describe the detrimental impact on a mother, her infant, and her family unit when postpartum/antenatal illnesses go unrecognized and untreated. The authors found that mothers who are depressed during pregnancy have poorer attendance in antenatal clinics than non- depressed pregnant women. They also found depressed women to be more likely to have poor weight gain and poor health behaviors such as smoking, drinking alcohol, and self-medicating with illicit substances such as cocaine. They speculate that the elevated catecholamine levels associated with depression could be associated with placental hypoperfusion. They also reported that women who were depressed during pregnancy (in contrast to those who were not) had higher rates of hospitalizations, were more likely to describe themselves as very tired or exhausted, and were sig-
nificantly more likely to report problems with weight gain and blood pressure. Depressed women were also much more likely to perceive their infants and their lives as more difficult after delivery and were more likely to use negative words to describe their babies than nondepressed postpartum mothers. Finally, depressed women were less likely to attempt breast-feeding and/or to persist with it (despite there being no difference in antenatal plans to breast-feed between groups). An overview of sweeping prevention strategies is presented, including examples such as identifying women known to be at high risk (unplanned pregnancy, limited social support, partner conflict, loss of status and support as a mother, isolation from others, previous history of psychiatric illness or depression, family history of depression, conflicted relationships, and/or lack of self- esteem and confidence). Health care providers were encouraged to allow new parents to open up and talk about their worries and concerns as a useful preventive intervention. The most useful part of this book for practitioners was the introduction of an excellent, straightforward screening tool, the Edinburgh Postnatal Depression Scale (EPDS), which has been specifically designed and standardized in the field of perinatal psychiatry. (The book also contains translations of the EPDS into 11 other languages with valuable guidance regarding cross-cultural research). The authors are careful to point out that no screening tool is sufficient by itself to impact actual care delivered. For a screening tool to be effective, clinical staff need to understand its purpose, be committed to its use, and be trained regarding cut-off scores and plans of action should a very depressed mother be discovered. These identified depressed patients must be
Psychosomatics 42:5, September-October 2001
Book Reviews effectively referred to quality treatment. Finally, the beneficial role of a liaison psychiatrist in obstetrics was described. The role involves working with obstetricians and family practitioners to establish quality screening programs, building strong liaison relationships, being available as a resource to coordinate optimal care, offering education and supervision, assisting with referrals, assessing an ill mother’s capacity and motivation to care for her newborn, and being available to assist with acute crises. In conclusion, the authors of Perinatal Psychiatry offer a generous gift to those in the field by sharing their expertise and their knowledge to improve care for women. Dr. Worley is at the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR.
Psychiatric Treatment of the Medically Ill Edited by Robert G. Robinson and William R. Yates New York, Marcel Dekker 1999, 564 pp ISBN 0-8247-1958-1 Reviewed by Molly Shores, M.D. Marcella Pascualy, M.D.
T
his book examines the boundary between medical and psychiatric disorders, which is an intriguing and important area for psychiatrists. Multiple studies have shown that psychiatric illness increases medical morbidity and mortality, increases cost of care, and decreases quality of life. In addition, the number of patients having both medical and psychiatric problems will likely increase markedly in the next decade as the population continues
to age. Psychiatrists and primary care practitioners will find this book to be a useful reference that provides an overview of the relevant psychiatric issues in a broad range of medical disorders. The book is divided into three sections: an introduction, a large section that discusses psychiatric aspects of specific medical disorders, and a concluding section on psychopharmacologic issues. The introductory section starts off with a well-written chapter on the significance of psychiatric illness in the medically ill and indications and usefulness of screening for psychiatric disorders. This is followed by chapters on the specificity of psychiatric symptoms in the medically ill and the epidemiology of psychiatric disorders in the medically ill. The introductory section is well-referenced and provides a useful framework for the subsequent chapters. The comprehensive section on medical illnesses consists of eighteen chapters that cover the most common medical disorders as well as those in which psychiatric issues may play a significant role. Generally, the chapters provide solid overviews and include several noteworthy chapters written by experts in the field. Highlights include an excellent review of cerebrovascular disease by Robinson and Paradiso, which begins with a historical perspective and then proceeds to review the different categories of cerebrovascular disease. This chapter is detailed and well referenced with thoughtful critiques of the published literature. The chapter on traumatic brain injury by Jorge and Robinson is equally comprehensive with excellent clinical descriptions of the cognitive, behavioral, and personality changes that these patients suffer. The neuropathology and neurochemical studies in this area are well summarized, and the treatment section
Psychosomatics 42:5, September-October 2001
offers the practitioner sound advice in the management of these difficult patients. The chapter on headaches by Merikangas et al. is well-written with an excellent overview of the classification of headaches. The case example, differential diagnosis, and clinical evaluation sections will ensure that the clinician will be able to perform a thorough evaluation of such patients. Yates provides an excellent review of liver disease, medical complications of liver disease, and treatment recommendations for psychiatric disorders in patients with liver disease. In addition, this chapter discusses how to perform an in-depth consult to evaluate a potential liver transplant candidate from a psychiatric perspective. The menstrual cycle disorder chapter by Johnson is succinct and clear with excellent figures and a comprehensive section on management, including self-help therapies, pharmacological therapies, ovulation inhibition, and surgical intervention. Other chapters that are particularly informative include the chapter on dementia by Ranen and Rovner, Parkinson’s disease by Starkstein and Petracca, and HIV by Treisman et al. These chapters provide pertinent information for any practitioner who treats patients with these disorders. Although, as indicated above, the chapters generally provide solid reviews, the chapter on sleep disorders by Barthlen is disappointingly brief and superficial. It does not address this highly prevalent clinical problem with the depth it deserves, and the inadequacy of this chapter is reflected in its scant reference section. The final section on psychopharmacology in the medically ill includes chapters on disorders affecting pharmacokinetics, monitoring serum drug levels, and the effects of aging on psychotropics and drug interactions. This 447
Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale Edited by John Cox and Jeni Holden London, The Royal College of Psychiatrists 1994, $35.00 ISBN 0-902241-68-0, 275 pp Reviewed by Linda Worley, M.D.
P
erinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale will likely be a resource on the shelves of professionals in the field of perinatal psychiatry for years to come. This publication grew out of the collective efforts of leaders in the field attending the Marce Society and the Centre for Reproductive Psychological
446
Medicine Conference in Keele, England, October, 1991. The agenda for the meeting was “to discuss the increasing use of the Edinburgh Postnatal Depression Scale (EPDS) in the United Kingdom and overseas within the context of strategies for prevention.” The resulting information was published in an effort to extend knowledge in the field and to disseminate practical methods for helping women. Overall, this book is a very useful resource for planning perinatal psychiatry programs, with two limitations. The first limitation is that it was published in 1994, which dates specific treatment recommendations (only one chapter). The second limitation is that model treatment and prevention programs were based on the health care resources available in the United Kingdom, which are not readily transferable to the United States (where a very different medical/legal climate exists, with limited postpartum outreach programs). The authors describe the detrimental impact on a mother, her infant, and her family unit when postpartum/antenatal illnesses go unrecognized and untreated. The authors found that mothers who are depressed during pregnancy have poorer attendance in antenatal clinics than non- depressed pregnant women. They also found depressed women to be more likely to have poor weight gain and poor health behaviors such as smoking, drinking alcohol, and self-medicating with illicit substances such as cocaine. They speculate that the elevated catecholamine levels associated with depression could be associated with placental hypoperfusion. They also reported that women who were depressed during pregnancy (in contrast to those who were not) had higher rates of hospitalizations, were more likely to describe themselves as very tired or exhausted, and were sig-
nificantly more likely to report problems with weight gain and blood pressure. Depressed women were also much more likely to perceive their infants and their lives as more difficult after delivery and were more likely to use negative words to describe their babies than nondepressed postpartum mothers. Finally, depressed women were less likely to attempt breast-feeding and/or to persist with it (despite there being no difference in antenatal plans to breast-feed between groups). An overview of sweeping prevention strategies is presented, including examples such as identifying women known to be at high risk (unplanned pregnancy, limited social support, partner conflict, loss of status and support as a mother, isolation from others, previous history of psychiatric illness or depression, family history of depression, conflicted relationships, and/or lack of self- esteem and confidence). Health care providers were encouraged to allow new parents to open up and talk about their worries and concerns as a useful preventive intervention. The most useful part of this book for practitioners was the introduction of an excellent, straightforward screening tool, the Edinburgh Postnatal Depression Scale (EPDS), which has been specifically designed and standardized in the field of perinatal psychiatry. (The book also contains translations of the EPDS into 11 other languages with valuable guidance regarding cross-cultural research). The authors are careful to point out that no screening tool is sufficient by itself to impact actual care delivered. For a screening tool to be effective, clinical staff need to understand its purpose, be committed to its use, and be trained regarding cut-off scores and plans of action should a very depressed mother be discovered. These identified depressed patients must be
Psychosomatics 42:5, September-October 2001
Book Reviews effectively referred to quality treatment. Finally, the beneficial role of a liaison psychiatrist in obstetrics was described. The role involves working with obstetricians and family practitioners to establish quality screening programs, building strong liaison relationships, being available as a resource to coordinate optimal care, offering education and supervision, assisting with referrals, assessing an ill mother’s capacity and motivation to care for her newborn, and being available to assist with acute crises. In conclusion, the authors of Perinatal Psychiatry offer a generous gift to those in the field by sharing their expertise and their knowledge to improve care for women. Dr. Worley is at the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR.
Psychiatric Treatment of the Medically Ill Edited by Robert G. Robinson and William R. Yates New York, Marcel Dekker 1999, 564 pp ISBN 0-8247-1958-1 Reviewed by Molly Shores, M.D. Marcella Pascualy, M.D.
T
his book examines the boundary between medical and psychiatric disorders, which is an intriguing and important area for psychiatrists. Multiple studies have shown that psychiatric illness increases medical morbidity and mortality, increases cost of care, and decreases quality of life. In addition, the number of patients having both medical and psychiatric problems will likely increase markedly in the next decade as the population continues
to age. Psychiatrists and primary care practitioners will find this book to be a useful reference that provides an overview of the relevant psychiatric issues in a broad range of medical disorders. The book is divided into three sections: an introduction, a large section that discusses psychiatric aspects of specific medical disorders, and a concluding section on psychopharmacologic issues. The introductory section starts off with a well-written chapter on the significance of psychiatric illness in the medically ill and indications and usefulness of screening for psychiatric disorders. This is followed by chapters on the specificity of psychiatric symptoms in the medically ill and the epidemiology of psychiatric disorders in the medically ill. The introductory section is well-referenced and provides a useful framework for the subsequent chapters. The comprehensive section on medical illnesses consists of eighteen chapters that cover the most common medical disorders as well as those in which psychiatric issues may play a significant role. Generally, the chapters provide solid overviews and include several noteworthy chapters written by experts in the field. Highlights include an excellent review of cerebrovascular disease by Robinson and Paradiso, which begins with a historical perspective and then proceeds to review the different categories of cerebrovascular disease. This chapter is detailed and well referenced with thoughtful critiques of the published literature. The chapter on traumatic brain injury by Jorge and Robinson is equally comprehensive with excellent clinical descriptions of the cognitive, behavioral, and personality changes that these patients suffer. The neuropathology and neurochemical studies in this area are well summarized, and the treatment section
Psychosomatics 42:5, September-October 2001
offers the practitioner sound advice in the management of these difficult patients. The chapter on headaches by Merikangas et al. is well-written with an excellent overview of the classification of headaches. The case example, differential diagnosis, and clinical evaluation sections will ensure that the clinician will be able to perform a thorough evaluation of such patients. Yates provides an excellent review of liver disease, medical complications of liver disease, and treatment recommendations for psychiatric disorders in patients with liver disease. In addition, this chapter discusses how to perform an in-depth consult to evaluate a potential liver transplant candidate from a psychiatric perspective. The menstrual cycle disorder chapter by Johnson is succinct and clear with excellent figures and a comprehensive section on management, including self-help therapies, pharmacological therapies, ovulation inhibition, and surgical intervention. Other chapters that are particularly informative include the chapter on dementia by Ranen and Rovner, Parkinson’s disease by Starkstein and Petracca, and HIV by Treisman et al. These chapters provide pertinent information for any practitioner who treats patients with these disorders. Although, as indicated above, the chapters generally provide solid reviews, the chapter on sleep disorders by Barthlen is disappointingly brief and superficial. It does not address this highly prevalent clinical problem with the depth it deserves, and the inadequacy of this chapter is reflected in its scant reference section. The final section on psychopharmacology in the medically ill includes chapters on disorders affecting pharmacokinetics, monitoring serum drug levels, and the effects of aging on psychotropics and drug interactions. This 447