Obstet Gynecol. 2017 Jul;130(1):e32-e41. doi: 10.1097/AOG.0000000000002160.
Mental health disorders in adolescence are a significant problem, relatively common, and amenable to treatment or intervention. Obstetrician-gynecologists who see adolescent patients are highly likely to see adolescents and young women who have one or more mental health disorders. Some of these disorders may interfere with a patient's ability to understand or articulate her health concerns and appropriately adhere to recommended treatment. Some disorders or their treatments will affect the hypothalamic-pituitary-gonadal axis, causing anovulatory cycles and various menstrual disturbances. Adolescents with psychiatric disorders may be taking psychopharmacologic agents that can cause menstrual dysfunction and galactorrhea. Adolescents with mental illness often engage in acting-out behavior or substance use, which increases their risk of unsafe sexual behavior that may result in pregnancy or sexually transmitted infections. Pregnant adolescents who take psychopharmacologic agents present a special challenge in balancing the potential risks of fetal harm with the risks of inadequate treatment. Whether providing preventive women's health care or specific obstetric or gynecologic treatment, the obstetrician-gynecologist has the opportunity to reduce morbidity and mortality from mental health disorders in adolescents by early identification, appropriate and timely referral, and care coordination. Although mental health disorders should be managed by mental health care professionals or appropriately trained primary care providers, the obstetrician-gynecologist can assist by managing the gynecologic adverse effects of psychiatric medications and providing effective contraception and regular screening for sexually transmitted infections. This Committee Opinion will provide basic information about common adolescent mental health disorders, focusing on specific implications for gynecologic and obstetric practice.
青少年心理健康障碍是一个重大问题，相对常见且可通过治疗或干预得到改善。诊治青少年患者的妇产科医生很可能会遇到患有一种或多种心理健康障碍的青少年和年轻女性。其中一些障碍可能会干扰患者理解或表达自身健康问题以及适当遵循推荐治疗的能力。一些障碍或其治疗方法会影响下丘脑 - 垂体 - 性腺轴，导致无排卵周期和各种月经紊乱。患有精神疾病的青少年可能正在服用可导致月经功能障碍和溢乳的精神药物。患有精神疾病的青少年常常表现出冲动行为或使用药物，这增加了他们发生不安全性行为的风险，而不安全性行为可能导致怀孕或性传播感染。服用精神药物的怀孕青少年在平衡胎儿潜在伤害风险与治疗不足风险方面面临特殊挑战。无论是提供预防性的妇女保健服务还是特定的妇产科治疗，妇产科医生都有机会通过早期识别、适当及时的转诊和护理协调来降低青少年心理健康障碍导致的发病率和死亡率。虽然心理健康障碍应由心理健康护理专业人员或经过适当培训的初级保健提供者进行管理，但妇产科医生可以通过处理精神药物的妇科不良反应以及提供有效的避孕措施和定期进行性传播感染筛查来提供帮助。本委员会意见将提供有关常见青少年心理健康障碍的基本信息，重点关注对妇产科实践的具体影响。
