Women and Schizophrenia Edited by David Castle John McGrath & Jayashri Kulkarni. Cambridge: Cambridge University Press 2000. 151 pp. £18.95 (pb). ISBN 0 521 78617 7

Research and psychiatric services for patients with schizophrenia are usually developed for men, as the archetypal patient with schizophrenia is male. A whole book on women and schizophrenia is therefore unusual, but Castle et al argue that understanding how women experience schizophrenia in biological, psychological and social domains can help our understanding of schizophrenia as a disorder. It is relatively well established that women with schizophrenia have, in general, fewer premorbid problems, a later age of onset of illness and a better response to treatment than men with this disorder. Other less well-known gender differences in epidemiology, clinical presentation, neuropsychology and neuroimaging are also reviewed, along with relevant animal and human studies of brain development and hormonal influences on psychosis. This literature review, the first third of the book, provides a useful broad perspective on gender differences in schizophrenia and highlights the importance of these differences in understanding psychotic disorders.

The second section of the book covers the scope for intervention in prenatal and postnatal care of these patients, particularly to prevent obstetric complications and potentially prevent psychosis in the next generation. Parental schizophrenia can influence child health in a number of ways, and some researchers have speculated that the impact of maternal schizophrenia is a growing problem because child-bearing in women with schizophrenia appears to have increased since the advent of community care. Although there is little clear research evidence of an increase in fertility, several studies have found that the majority of women with psychotic disorders have children. The compartmentalised nature of health and social services for these families is highlighted, although there are no easy answers on how to integrate the support needed by these families and how these services can help. There is little mention of what patients themselves perceive as their main problems and needs, but this reflects the paucity of qualitative research in this area.

Treatment implications of gender differences are intriguing, although somewhat speculative, and many relatively new questions about management of schizophrenia in women are discussed. Is depot contraception, which is relatively commonly given to women with schizophrenia, counterproductive in the central nervous system owing to its effect on inhibiting the production of oestrogen in the ovaries? Should postmenopausal women with schizophrenia be prescribed hormone replacement therapy as part of their treatment? Are women with schizophrenia at increased risk of osteoporosis and should they be offered routine bone-density assessment at the time of the menopause? This very readable book cannot provide definitive answers but the questions it raises are worth reading.