El suicidio de un paciente. Impacto en el psiquiatra / [A patient’s suicide. The psychiatrist’s impact].

The clinical work of the psychiatrist often faces him to people who openly talk about their wish to die. However, although such thoughts did not culminate in most cases, unfortunately statistics show that suicide is a concrete possibility, more frequent than suspected. Globally, a million people die by suicide each year. The will to kill themselves is a complex phenomenon that is neither new nor modern. Suicide has crossed different times adopting different forms and meanings according to culture and history. As doctors, we tend to describe behaviors, in this case highly such a variable one, which involves various reasons and determinants. Thus, much has been written in the scientific literature about suicide in the causes, risk and protective factors, most vulnerable groups, etc. It has also been remarked the pain that the suicide causes in the family and close friends. Lots of articles propose psychotherapeutic and supporting measures for the suicide survivors to avoid the traumatic consequences of the experience. But, what about the psychiatrist? Isn’t him a person who has been in close contact with the subject who has killed himself? The survivor risk of having traumatic symptoms, does it not apply to the doctor who was in charge? In this article, it will be taken into account the point of view of the psychiatrist in the grief after a patient’s suicide.

Trastornos psiquiátricos del puerperio / [Postpartum psychiatric disorders].

The postpartum period represents a very particular time in women’s life, the beginning of a new bond, the maternity. As many times, beginnings are such turbulent, intense. In this period the women suffers deep changes in their hormonal status, with its body and changes and affective oscillations. Women are often so labile at this time, ranging from happiness to deep sadness. The vast majority suffers the blues, a benign form of mild depressive state. On the other hand, 20

may have a major depressive episode, and a much less percentage will suffer the most disruptive postpartum syndrome, the postpartum psychosis. In this paper it will be described the symptomatology of such cases, the most important treatment approaches and will focus on the clinical dilemma of using psychotropic medications during breastfeeding.

Embarazo y depresión / Pregnancy and depression

La situación clínica que representa la coexistencia de un episodio depresivo en el transcurso de un embarazo en la vida de una mujer, reviste una gran complejidad y obliga al psiquiatra a evaluar múltiples variables. La alta prevalencia de depresión en las mujeres y la coincidencia temporal con la edad fértil, hace que dicha eventualidad no sea una rareza, sino más bien un escenario posible y frecuente. En este capítulo se describen las características clínicas de la depresión antenatal, se dan pautas de tratamiento teniendo en consideración los cambios farmacocinéticos del embarazo, se discute el dilema clínico sobre el uso de la medicación psicofarmacológica en la gestación y su posible impacto en el desarrollo obstétrico y en el neonato, y se dimensionan las consecuencias de la patología psiquiátrica no tratada. Se propone un abordaje racional sobre la correcta evaluación de los riesgos de la conducta a adoptar; es decir, la valoración del riesgo de la medicación en el embarazo, el riesgo de no medicar a una embarazada cuando la depresión lo amerita y el impacto de la patología psiquiátrica sobre la mujer, el embarazo en sí y el recién nacido.

The clinical situation representing the co-existence of a depressive episode during the course of a pregnancy in a woman's life is very complex and obliges the Psychiatrist to evaluate multiple variables. The high prevalence of depression among women, and the temporal coincidence with childbearing age makes this eventuality not strange, but rather a possible and frequent scenario. In this chapter, the author describes the clinical characteristics of antenatal depression, provides the treatment guidelines taking into consideration the pharmacokinetic changes of pregnancy, discusses the clinical dilemma on the use of psychopharmacological medication during conception and its possible impact on the obstetric development and the newly born, and measures the consequences of untreated psychiatric pathoogy. The author proposes a rational approach to the correct evaluation of the risks of the behavior to be adopted; that is to say, the assessment of the risk of the medication in pregnancy, the risk of not medicating a pregnant woman when depression calls for it, and the impact of the psychiatric pathology on the woman, the pregnancy itself and the newly born.