oa Editorial [ Hot Topic:Reproductive Issues for Women with Sclizophrenia(Guest Editors: Mary V. Seeman and Laura J. Miller) ]

Schizophrenia presents differently in women than in men, somewhat later in life on average and, initially, in a more benign way. Women who later experience psychotic symptoms often report childhoods and teenage years relatively free of problems. They do well in school, have friends, and keep jobs. By the time illness comes, they may be mothers. Even after the beginning of symptoms, they do well relative to men. They generally respond positively to treatment, continue to maintain a network of friends, and may be able work at jobs outside the home or in the home, looking after their families. Schizophrenia wreaks a lesser toll on thought processes in women than it does in men and they usually retain a wide range of emotions and an ability to take pleasure in life. They are less withdrawn and isolated than men with this illness. On testing, their brains appear comparatively immune to the ravages inflicted by the schizophrenia process on the brains of men. Of course, this is all relative. In many ways, the lot of women with schizophrenia is very difficult. Compared to the general population, proportionally more women than men with schizophrenia take their own lives. They have more unmet service needs than men in three important areas: physical health, safety, and child care [1-3]. The series that follows, focused on the reproductive needs of women with schizophrenia, addresses aspects of medical health, treatment, law, ethics and safety, and parenting. The first paper, by Sarah Romans, discusses sexuality in the context of women with schizophrenia, an important topic not often addressed in the psychiatric literature. A key conclusion is made: the quality of sexual experience for women with schizophrenia is poor. When women with schizophrenia take control of their lives, they will want answers to the questions that most directly affect their pleasure and well-being. How should clinicians advise women with schizophrenia who come for preconception counseling? This question is addressed by Ariela Frieder. She concludes that it important to provide services for such women because they are at a high risk of psychotic symptoms during pregnancy, which, if untreated, can lead to fetal distress. They are at increased risk of fetal malformations, obstetrical and neonatal complications, and postpartum exacerbation of psychosis. Attention needs to be paid to their living accommodations, disposable income, social support and parenting skills in order to make childbearing safe. Simone Vigod and Lori Ross continue this theme. They address the epidemiology of psychotic symptoms during pregnancy and postpartum in women with schizophrenia. They conclude that, although risk factors for psychosis in the perinatal period are poorly characterized, the level of pre-existing illness, medication non-adherence and poor social support are all likely to be relevant. If not in place, they advocate preventive and intervention services in the perinatal period.