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Prof. Anita Riecher-Rössler

Anita Riecher-Rössler psiquiatra Controversias Psiquiatria Barcelona
Universität Basel, Suissa
Ponència El gènere afegeix complexitat als trastorns mentals?
Data Divendres, 20 d'Abril 2018
Hora 9:00 a 9:45
Taula rodona Complexitats etiològiques

BIOGRAFIA

Anita Riecher-Rössler, MD PhD, has a full chair for Psychiatry at the University of Basel and is Head of the University Psychiatric Center for Gender Research and Early Detection at the Psychiatric University Clinics in Basel, Switzerland.

Her research interests have been in the field of schizophrenic psychoses and that of gender differences in mental disorders.

Her primary focus in the field of schizophrenic psychoses has been on emerging psychoses and their early detection, but also on late-onset schizophrenia and on gender differences and the influence of estrogens on these disorders..

Her other main research focus has been on the specific aspects of mental disorders in women, particularly on psychoneuroendocrine or psychosocial risk factors. This is reflected by works on mental disorders in the peripartum or during the menopausal transition on the one hand and on the other hand, by works on violence against women.

She has published about 330 original publications, 28 books and 97 book chapters (cumulative impact factor ca. 1000, h-Index 45). She is series editor of "Key Issues in Mental Health".

RESUM

In most countries psychiatry and psychotherapy still lack gender sensitivity, although there are many gender differences regarding mental disorders, and men and women often have specific needs regarding diagnostic approaches and treatment.

Many disorders show gender differences in incidence and prevalence, psychopathology and course as well as regarding risk and protective factors. Further topics are gender differences in illness perception, coping and help-seeking behavior, the specificities of psychopharmacotherapy and the special needs in psychotherapy.

Although mental illnesses are equally common in both men and women, women are significantly more likely to suffer from depression, anxiety, and eating disorders or to attempt suicide. Men, on the other hand, are more likely to suffer from addictive disorders, certain personality disorders, and are more likely to “successfully” commit suicide. Schizophrenic psychoses have a later age of onset in women with a second peak of onsets around menopause. Perimenopause seems to bear an enhanced risk for depression. The causes of these gender differences are complex and multifold, lying partly in the biological “sex”, partly in the psychosocially and culturally determined “gender”.

On the biological side we mainly deal with hormonal influences. Thus, sex hormones, especially estrogens, obviously do not only influence brain development but also current mental wellbeing. This is especially true for 17-β-estradiol, the natural estrogen that is most active in the brain. It is known to be neuroprotective and also seems to be psychoprotective, mainly by modulating neurotransmitter systems. Recent research indicates that it might improve affective and psychotic symptoms, aggressive and suicidal behavior, stress reactivity and cognitive functioning.

Also on the psychosocial side many influencing factors regarding the pathogenesis and course of mental disorders are being discussed. The differing early socialization of boys and girls seems to be important as it lays the ground for later gender differences in personality and role behavior, such as the on average lower self-esteem and less active problem-solving behavior of women as compared to men. This can be associated with differing coping strategies in personal crises with women rather tending to blame themselves, internalizing, ruminating, feeling guilty and developing depression, and men, in contrast, more tending to seek active problem solving, externalizing and acting out.

Further risk factors might stem from the differing social stressors of men and women. Thus, for example, women might more often than men suffer from discrimination, sexual abuse, and domestic violence.

Gender-sensitive diagnostic and treatment approaches address gender differences and gender needs of both men and women. Psychotherapy has to take into account the mentioned psychosocial influencing and risk factors as well as “gender-typical” cognitions, emotions, and behaviors. Also in psychopharmacotherapy it is important to consider gender differences, such as differences in pharmacokinetics and –dynamics or, most importantly, the specific risks in fertile women regarding teratogeneity. Furthermore, the influence of sex hormones and their interactions with psychotropic drugs have to be considered – be it the influence of physiological serum hormone levels and their fluctuations during the menstrual cycle or the female life cycle, be it the influence of hormonal therapies such as the contraceptive pill or hormone replacement in perimenopause. Indications and contraindications for hormone therapy should be known in order to cooperate with gynaecologists and endocrinologists.

Although there is a big overlap between men and women, their mental health is influenced by different vulnerabilities, risk and protective factors. Neglecting this might hamper the detection of potentially differing causal pathways and treatment responses in both women and men and result in a failure to deliver optimal personalized gender-sensitive treatments. Further research, education and practice should therefore much more integrate sex and gender aspects.

REFERÈNCIES

[PDF] Riecher-Rössler A (2017). Oestrogens, prolactin, hypothalamic-pituitary-gonadal axis, and schizophrenic psychoses, Lancet Psychiatry. 2017 Jan;4(1):63-72. doi: 10.1016/S2215-0366(16)30379-0. Epub 2016 Nov 15.

[PDF] Riecher-Rössler A (2017). Sex and gender differences in mental disorders, Lancet Psychiatry. 2017 Jan;4(1):8-9. doi: 10.1016/S2215-0366(16)30348-0. Epub 2016 Nov 15.

[PDF brief] Garcia-Moreno C, Riecher-Rössler A (2013). Violence against women and mental health, (volume eds.): Violence against women and mental health. Riecher-Rössler A, Sartorius N (series eds.) Key Issues in Mental Health Vol. 178.Basel, Karger, 2013.

[PDF] Riecher-Rössler A (2009) Psychotic disorders and menopause: the untold story, In: Soares C, Warren M (volume eds.): The menopausal transition - interface between gynecology and psychiatry. Riecher-Rössler A, Steiner M (series eds.) Key Issues in Mental Health Vol. 175. Basel, Karger, pp 115-126.