unusual, but Castle unusual, but Castle et al et al argue that under-argue that understanding how women experience schizo-standing how women experience schizophrenia in biological, psychological and phrenia in biological, psychological and social domains can help our understanding social domains can help our understanding of schizophrenia as a disorder. It is rela-of schizophrenia as a disorder. It is relatively well established that women with tively well established that women with

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... ia have, in general, fewer pre-schizophrenia have, in general, fewer premorbid problems, a later age of onset of morbid problems, a later age of onset of illness and a better response to treatment illness and a better response to treatment than men with this disorder. Other less than men with this disorder. Other less well-known gender differences in epide-well-known gender differences in epidemiology, clinical presentation, neuropsy-miology, clinical presentation, neuropsychology and neuroimaging are also chology and neuroimaging are also reviewed, along with relevant animal and reviewed, along with relevant animal and human studies of brain development and human studies of brain development and hormonal influences on psychosis. This hormonal influences on psychosis. This literature review, the first third of the book, literature review, the first third of the book, provides a useful broad perspective on provides a useful broad perspective on gender differences in schizophrenia and gender differences in schizophrenia and highlights the importance of these differ-highlights the importance of these differences in understanding psychotic disorders. ences in understanding psychotic disorders. The second section of the book covers The second section of the book covers the scope for intervention in prenatal and the scope for intervention in prenatal and postnatal care of these patients, particularly postnatal care of these patients, particularly to prevent obstetric complications and to prevent obstetric complications and potentially prevent psychosis in the next potentially prevent psychosis in the next generation. Parental schizophrenia can in-generation. Parental schizophrenia can influence child health in a number of ways, fluence child health in a number of ways, and some researchers have speculated that and some researchers have speculated that the impact of maternal schizophrenia is a the impact of maternal schizophrenia is a growing problem because child-bearing in growing problem because child-bearing in women with schizophrenia appears to have women with schizophrenia appears to have increased since the advent of community increased since the advent of community care. Although there is little clear research care. Although there is little clear research evidence of an increase in fertility, several evidence of an increase in fertility, several studies have found that the majority of studies have found that the majority of women with psychotic disorders have women with psychotic disorders have children. The compartmentalised nature of children. The compartmentalised nature of health and social services for these families health and social services for these families is highlighted, although there are no easy is highlighted, although there are no easy answers on how to integrate the support answers on how to integrate the support needed by these families and how these needed by these families and how these services can help. There is little mention of services can help. There is little mention of what patients themselves perceive as their what patients themselves perceive as their main problems and needs, but this reflects main problems and needs, but this reflects the paucity of qualitative research in this the paucity of qualitative research in this area. area. Treatment implications of gender dif-Treatment implications of gender differences are intriguing, although somewhat ferences are intriguing, although somewhat speculative, and many relatively new ques-speculative, and many relatively new questions about management of schizophrenia in tions about management of schizophrenia in women are discussed. Is depot contracep-women are discussed. Is depot contraception, which is relatively commonly given to tion, which is relatively commonly given to women with schizophrenia, counterproduc-women with schizophrenia, counterproductive in the central nervous system owing to tive in the central nervous system owing to its effect on inhibiting the production of its effect on inhibiting the production of oestrogen in the ovaries? Should post-oestrogen in the ovaries? Should postmenopausal women with schizophrenia be menopausal women with schizophrenia be prescribed hormone replacement therapy as prescribed hormone replacement therapy as part of their treatment? Are women with part of their treatment? Are women with schizophrenia at increased risk of osteo-schizophrenia at increased risk of osteoporosis and should they be offered routine porosis and should they be offered routine bone-density assessment at the time of the bone-density assessment at the time of the menopause? This very readable book can-menopause? This very readable book cannot provide definitive answers but the not provide definitive answers but the questions it raises are worth reading. questions it raises are worth reading.