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Medical Rounds

Psychiatry: Filling Gaps in Reproductive Psychiatry

Throughout her residency, Johns Hopkins psychiatrist Lauren Osborne noticed how little training some of her colleagues were getting in reproductive psychiatry—the assessment and treatment of psychiatric symptoms arising in women during hormonal transitions such as pregnancy or perimenopause. It hit home while Osborne pursued a research fellowship in women’s mental health.

“Ten of the 11 other people I went to residency with called me within their first three months of practice to ask me a question about treating a pregnant woman,” says Osborne, assistant director of Johns Hopkins’ Women’s Mood Disorders Center. “What that said to me was that all of these people entering all areas of psychiatry felt unprepared to manage pregnancy-related issues.”

Now, Osborne and some 40 colleagues across the country are looking to turn things around through the creation of a national curriculum on reproductive psychiatry. The program, aimed at prescribers and established by the National Task Force on Women’s Reproductive Mental Health (chaired by Osborne), covers 15 topics, including perinatal depression and bipolar disorders, eating disorders in pregnancy, infertility and perinatal loss.

Materials are packaged into three modalities: comprehensive, downloadable guides that can be taught to residents in a classroom, even if the facilitator has no expertise in women’s mental health; supplemental videos and interactive exercises a trainee can complete through self-study; and short exams, offering continuing medical education (CME) credit, on each of the 15 areas. The materials will be pilot-tested in five residency programs, including Johns Hopkins, then made available online. The only charge will be for the CME exams.

The project arose from a 2013 national perinatal mental health conference, when Osborne and colleagues summarized the state of education in reproductive psychiatry and went on to survey residency directors about program requirements and attitudes. They discovered that the biggest barriers to teaching reproductive psychiatry to residents were lack of time and faculty expertise.

It was a “lightbulb” moment, recalls Osborne, whose group realized it could provide that expertise from afar. All of the classroom materials have a facilitator’s guide containing an answer key and references, which enables any psychiatric provider to lead the discussion. Osborne received the 2018 Educational Innovation Award from Johns Hopkins’ Institute for Excellence in Education for the project.

“I want every general psychiatrist to have some minimum knowledge of how to treat a woman during pregnancy and the postpartum period so I can avoid the disasters that come into my office regularly—women whose medications have been stopped erroneously during pregnancy and who then become very ill,” says Osborne. While managing some conditions requires advanced skills, she notes, psychiatrists should at least be able to handle basic concerns and know where to refer patients if they need additional assistance.

Another goal is getting the psychiatric community to recognize that reproductive psychiatry is an important subspecialty, she says: “We require every general psychiatrist to learn something about how to treat children, older adults and those with substance use disorders, but we don’t require them to learn how to treat women. I hope the existence of this curriculum and surrounding buzz will get people talking and change some of those attitudes.”