Obsessive–Compulsive Disorder in the Postpartum Period: Diagnosis, Differential Diagnosis and Management (original) (raw)
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Postpartum-Onset Obsessive-Compulsive Disorder: Incidence, Clinical Features, and Related Factors
Journal of Clinical Psychiatry, 2007
The postpartum period is associated with an increased risk of developing obsessive-compulsive disorder (OCD) in women. Postpartum onset OCD is often undiagnosed and untreated resulting in serious consequences for the patient, her family and the newborn. The symptoms of postpartum onset OCD may consist of obsessional intrusive thoughts about harming the newborn without compulsions or with both obsessions and compulsions. In this review, the phenomenology of postpartum onset OCD is described as well as strategies for screening and diagnosis. The review also characterizes the differences between postpartum onset OCD and postpartum depression and postpartum psychosis and explores strategies for managing postpartum onset OCD patients. Issues regarding pharmacologic treatment of OCD in breastfeeding mothers are also reviewed.
Onset and Exacerbation of Obsessive-Compulsive Disorder in Pregnancy and the Postpartum Period
The Journal of Clinical Psychiatry, 2010
Background-The primary goal of this study was to examine the impact of pregnancy, childbirth and menstruation on the onset of obsessive-compulsive disorder (OCD) and/or exacerbation of OCD symptoms. Method-One hundred twenty-six women attending a university-based OCD clinic aged 18-69 years who met DSM-IV criteria for OCD according to the Structured Clinical Interview for DSM-IV Disorders were interviewed retrospectively to assess OCD onset and symptom exacerbation in relationship to reproductive events. Women were placed into two groups: ever pregnant (Preg) and never pregnant (NPreg). The Preg group was further subdivided into those who reported onset of OCD in the perinatal period (perinatal-related, PR) and those that denied onset related to pregnancy (non-perinatal-related, NR). Between groups comparisons were done using a Student's t-test for continuous measures and categorical variables were assessed using the chi-square test. Results-Of the 76 women in the Preg group, 32.1% (N = 25) had OCD onset in the perinatal period (PR group), 15.4% in pregnancy, 15.4% at postpartum, and 1.3% following miscarriage. Out of 132 total pregnancies, 34.1% involved an exacerbation of symptoms, 22.0% involved an improvement in OCD symptoms, and 43.9% did not change symptom severity in women with preexisting illness. Women in the PR group and women with perinatal worsening of pre-existing OCD were more likely to have premenstrual worsening of OCD symptoms compared to NR women (65.5% vs. 39.3%, p = 0.047). Conclusion-Findings from this study provide additional evidence that pregnancy and childbirth are frequently associated with the onset of OCD or worsening of symptoms in those with pre-existing disorder. In addition, there appears to be continuity between OCD onset and/or exacerbation across the reproductive life cycle, at least with menstruation and pregnancy.
Archives of Women's Mental Health, 2015
Purpose-To examine the course of obsessive-compulsive disorder (OCD) across pregnancy and its impact on obstetric and neonatal outcomes. Methods-Women enrolled prior to 20 weeks gestation in a prospective, observational study. The Structured Clinical Interview for DSM-IV was completed to obtain lifetime Axis I diagnoses. A total of 56 women with OCD were followed at 1 to 3 month intervals through 52 weeks postpartum. Each visit, the Yale-Brown Obsessive Compulsive Scale (YBOCS), clinical assessment, and medication/exposure tracking was performed. Obstetric and neonatal data was abstracted from the medical record. In subjects with OCD, associations between perinatal obsessive-compulsive symptoms (OCS) and outcomes were examined. Additionally, outcomes were compared to 156 matched psychiatric patients without OCD. Results-Maternal age inversely correlated with the YBOCS scores across the study period (β =-0.5161, p = .0378). Caesarean section was associated with increased OCS in the postpartum period compared to vaginal delivery (β = 5.3632, p = 0.043). No associations were found between severity of perinatal obsessions or compulsions with any specific obstetric or neonatal complications. Subjects without OCD had higher frequency of fetal loss compared to mothers with OCD (χ² = 4.03, p = 0.043). Conclusions-These novel prospective data fail to identify an association of OCS with adverse outcomes. In contrast, there is an association of delivery method and younger maternal age with increased postnatal symptoms of OCD. Psychiatric subjects without OCD may have a higher risk of miscarriage and intrauterine fetal demise compared to subjects with OCD.
Bulletin of Clinical Psychopharmacology, 2015
Pregnancy-onset obsessive-compulsive disorder: clinical features, comorbidity, and associated factors Objective: The prevalence rate of obsessive-compulsive disorder (OCD) was found to be higher in women during pregnancy and puerperium than that estimated in the general population. Additionally, the symptomatology of OCD shows several variations during the lifetime of women. Objective of the current study was to examine the clinical characteristics and comorbidity with other anxiety and mood disorders of pregnancy-onset obsessive-compulsive disorder (POCD) and to investigate factors related to POCD. Method: The study sample was composed of three groups. The first group (POCD group) included 20 consecutive pregnant women meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for OCD, showing an onset of OCD during their current pregnancy. The second group (non-OCD group) consisted of 207 consecutive pregnant women without any mood or anxiety disorders to assess factors associated with POCD. In addition, the study included a control group to compare the symptoms of POCD and non-pregnancy-onset OCD. The control group was composed of 40 nonpregnant female outpatients with OCD. Type and severity of obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). OCD and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV (SCID-I). Comorbid axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Results: The mean onset time of OCD in the POCD group was 13.3±6.35 (week5-28) gestational weeks. OCD occurred during the first trimester of pregnancy in 9 women (45%), during the second trimester in 10 (50%) women, and during the third trimester in 1 (5%) woman. The most common obsessions were contamination (n=16, 80%) and symmetry/exactness (n=6, 30%), and the most common compulsions were cleaning/ washing (n=16, 80%) and checking (n=12, 60%) in POCD. Thirteen (65%) of the pregnant OCD patients met the criteria for a mood or anxiety disorder. Generalized anxiety disorder was the most frequently diagnosed axis I disorder (40%, n=8). The independent factors associated with POCD were cigarette smoking (p=0.002), the existence of an anxiety disorder at onset of pregnancy (p=0.000), and obsessive-compulsive personality disorder (p=0.003). Conclusion: The present study suggests that POCD presents similar clinical characteristics with nonpregnancy-onset OCD. Mood or anxiety disorder comorbidity is observed in more than half of the women with POCD. Additionally, pregnant women who have at least one of 3 factors (cigarette smoking, the existence of an anxiety disorder at onset of pregnancy, and obsessive-compulsive personality disorder) seem to be at risk for POCD.
Obsessive - compulsive disorder - course during pregnancy, exacerbation factors - literature review
Journal of Education, Health and Sport
Introduction and purpose of the work: The period of pregnancy and puerperium is the time of increased vulnerability for mother’s mental deterioration. While disorders such as perinatal depression have been detailed, an impact of pregnancy on the course of other mental disorders such as OCD is less investigated. The purpose of this work was to draw attention to the factors that may influence exacerbation of obsessions and compulsions in pregnancy and during the postpartum period. The most common obsessions and compulsions of pregnant women and the influence of mother’s OCD on the newborn have also been described in this research. State of knowledge: Factors such as mother’s age, duration of pregnancy, method of delivery may be predictors of aggravation of obsessions and compulsions. Gestational diabetes, thyroid hormones levels, personality disorders of the mother, stress, cultural beliefs also have an impact on mother’s OCD. Infant being infected or hurt are the most common obse...
Although there are a large number of studies on postpartum illnesses, such as depression and psychosis, only recently have perinatal anxiety disorders received attention. A number of studies indicate that there can be a rapid onset or exacerbation of Obsessive-Compulsive Disorder (OCD) during pregnancy. This article reviews the extant research on pregnancy-related OCD. Due to their small samples and the retrospective nature of most of the studies, the prevalence and course of pregnancy-related OCD remains unclear. However, research in this area has demonstrated that in contrast to the heterogeneous symptomatology generally observed in OCD, the clinical characteristics of obsessions and compulsions in pregnancy are relatively homogeneous, with fear of contamination and compulsive cleaning the predominant features. The article discusses biological and psychosocial factors as possible causes of OCD, as well as potential directions for
Pregnancy-induced obsessive compulsive disorder: a case report
Annals of general psychiatry, 2005
Pregnancy is a well-recognised risk factor in precipitating obsessive-compulsive disorder. We present and discuss a case with the onset of obsessive-compulsive disorder in the fourth month of gestation, which fully recovered two weeks after delivery. The phenomenology of the observed disorder was similar to earlier reports of obsessive-compulsive disorder in pregnancy, i.e. the obsessions and compulsions were predominantly related to the concern of contaminating the foetus resulting in washing compulsions. Despite the initial success with anti-obsessional drugs, the patient stopped the medication in the last month of gestation. Nevertheless, she fully recovered two weeks after the delivery without any psychiatric intervention. There were no obsessive-compulsive symptoms at one-year follow up. The possible mechanisms involved in the aetiology of this case, and future research directions in understanding the role of pregnancy in OCD are discussed.