Advertisement

New Mothers with Disturbing Thoughts: Treatment of Obsessive-Compulsive Disorder and of Psychosis in Postpartum

  • Vesna Pirec
  • Agnieszka Grabowski
Chapter

Abstract

Psychiatric symptoms in postpartum tend to vary in severity and presentation. As a result, they may be challenging to adequately recognize and treat. In this chapter, we will focus on postpartum obsessive-compulsive disorder and postpartum psychosis. Both of these psychiatric illnesses can have intrusive thoughts of hurting the child as a central theme. It is imperative to promptly identify them, determine severity of presentation, and assist women in obtaining treatment. If symptoms remain undetected, serious and sometimes lethal consequences for both mother and child could follow.

A case for each disorder is presented. Neither woman had significant previous psychiatric illness, which created additional diagnostic and treatment challenges.

Keywords

Postpartum Puerperium Obsessions Compulsions OCD Intrusive images Intrusive thoughts Psychosis in puerperium Bipolar disorder Postpartum mental illness 

References

  1. 1.
    World Health Organization. International statistical classification of diseases and related health problems. 10th rev. Geneva: World Health Organization; 2011.Google Scholar
  2. 2.
    Grigoriadis S, Romans S. Postpartum psychiatric disorders: what do we know and where do we go? Curr Psychiat Rev. 2006;2(1):151–8.CrossRefGoogle Scholar
  3. 3.
    Forray A, Focseneanu M, Pittman B, McDougle CJ, Epperson CN. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry. 2010;71(8):1061–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Brandes M, Soares CN, Cohen LS. Postpartum onset obsessive-compulsive disorder: diagnosis and management. Arch Womens Ment Health. 2004;7(2):99–110.CrossRefPubMedGoogle Scholar
  5. 5.
    Speisman BB, Storch EA, Abramowitz JS. Postpartum obsessive-compulsive disorder. J Obstet Gynecol Neonatal Nurs. 2011;40(6):680–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Sichel DA, Cohen LS, Dimmock JA, Rosenbaum JF. Postpartum obsessive compulsive disorder: a case series. J Clin Psychiatry. 1993;54(4):156–9.PubMedGoogle Scholar
  7. 7.
    Zambaldi CF, Cantilino A, Montenegro AC, Paes JA, de Albuquerque TL, Sougey EB. Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics. Compr Psychiatry. 2009;50(6):503–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Uguz F, Akman C, Kaya N, Cilli AS. Postpartum-onset obsessive-compulsive disorder: incidence, clinical features, and related factors. J Clin Psychiatry. 2007;68(1):132–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Fairbrother N, Woody SR. New mothers’ thoughts of harm related to the newborn. Arch Womens Ment Health. 2008;11(3):221–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry. 2013;74(4):377–85.CrossRefPubMedGoogle Scholar
  11. 11.
    Kitamura T, Yoshida K, Okano T, Kinoshita K, Hayashi M, Toyoda N, et al. Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression. Arch Womens Ment Health. 2006;9(3):121–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord. 2005;19(3):295–311.CrossRefPubMedGoogle Scholar
  13. 13.
    Wenzel A, Gorman LL, O’Hara MW, Stuart S. The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: a prospective study. Arch Womens Ment Health. 2001;4(1):5–12.CrossRefGoogle Scholar
  14. 14.
    Navarro P, Garcia-Esteve L, Ascaso C, Aguado J, Gelabert E, Martin-Santos R. Non-psychotic psychiatric disorders after childbirth: prevalence and comorbidity in a community sample. J Affect Disord. 2008;109(1–2):171–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR. Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord. 2003;17(4):461–78.CrossRefPubMedGoogle Scholar
  16. 16.
    Abramowitz J, Schwartz S, Moore K. Obsessional thoughts in postpartum females and their partners: content, severity, and relationship with depression. J Clin Psychol Med Settings. 2003;10(3):157–64.CrossRefGoogle Scholar
  17. 17.
    Stewart DE, Klompenhouwer JL, Kendell RE, van Hulst AM. Prophylactic lithium in puerperal psychosis. The experience of three centres. Br J Psychiatry. 1991;158:393–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Chaudron LH, Pies RW. The relationship between postpartum psychosis and bipolar disorder: a review. J Clin Psychiatry. 2003;64(11):1284–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry. 2001;158(6):913–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Brockington IF. Motherhood and mental health. Oxford: Oxford University Press; 1996.Google Scholar
  21. 21.
    Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150(5):662–73.CrossRefPubMedGoogle Scholar
  22. 22.
    Robertson E, Jones I, Haque S, Holder R, Craddock N. Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis. Br J Psychiatry. 2005;186:258–9.CrossRefPubMedGoogle Scholar
  23. 23.
    O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):3–12.CrossRefPubMedGoogle Scholar
  24. 24.
    Doucet S, Dennis CL, Letourneau N, Blackmore ER. Differentiation and clinical implications of postpartum depression and postpartum psychosis. J Obstet Gynecol Neonatal Nurs. 2009;38(3):269–79.CrossRefPubMedGoogle Scholar
  25. 25.
    Spinelli MG. Postpartum psychosis: detection of risk and management. Am J Psychiatry. 2009;166(4):405–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Brockington IF, Cernik K, Schofield E, Downing A, Francis A, Keelan C. Puerperal psychosis: phenomena and diagnosis. Arch Gen Psychiatry. 1981;38(7):829–33.CrossRefPubMedGoogle Scholar
  27. 27.
    Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Womens Health (Larchmt). 2006;15(4):352–68.CrossRefGoogle Scholar
  28. 28.
    Wisner KL, Peindl K, Hanusa BH. Symptomatology of affective and psychotic illnesses related to childbearing. J Affect Disord. 1994;30(2):77–87.CrossRefPubMedGoogle Scholar
  29. 29.
    Connell M. The postpartum psychosis defense and feminism: more or less justice for women? Case W Res L Rev. 2002;53(1):143.Google Scholar
  30. 30.
    Nau LN, McNiel DE, Binder RL. Postpartum psychosis and the courts. J Am Acad Psychiatry Law. 2012;40(3):318–25.PubMedGoogle Scholar
  31. 31.
    Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association; 2013.Google Scholar
  32. 32.
    Parry B. Postpartum psychiatric syndromes. In: Kaplan H, Sadock B, editors. Comprehensive textbook of psychiatry. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.Google Scholar
  33. 33.
    Doucet S, Jones I, Letourneau N, Dennis CL, Blackmore ER. Interventions for the prevention and treatment of postpartum psychosis: a systematic review. Arch Womens Ment Health. 2011;14(2):89–98.CrossRefPubMedGoogle Scholar
  34. 34.
    Fairbrother N, Abramowitz JS. New parenthood as a risk factor for the development of obsessional problems. Behav Res Ther. 2007;45(9):2155–63.CrossRefPubMedGoogle Scholar
  35. 35.
    Abramowitz JS, Khandker M, Nelson CA, Deacon BJ, Rygwall R. The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behav Res Ther. 2006;44(9):1361–74.CrossRefPubMedGoogle Scholar
  36. 36.
    Barr LC, Goodman WK, Price LH. The serotonin hypothesis of obsessive compulsive disorder. Int Clin Psychopharmacol. 1993;8 Suppl 2:79–82.CrossRefPubMedGoogle Scholar
  37. 37.
    Leckman JF, Goodman WK, North WG, Chappell PB, Price LH, Pauls DL, et al. Elevated cerebrospinal fluid levels of oxytocin in obsessive-compulsive disorder. Comparison with Tourette’s syndrome and healthy controls. Arch Gen Psychiatry. 1994;51(10):782–92.CrossRefPubMedGoogle Scholar
  38. 38.
    Bergink V, Gibney SM, Drexhage HA. Autoimmunity, inflammation, and psychosis: a search for peripheral markers. Biol Psychiatry. 2014;75(4):324–31.CrossRefPubMedGoogle Scholar
  39. 39.
    Bergink V, Lambregtse-van den Berg MP, Koorengevel KM, Kupka R, Kushner SA. First-onset psychosis occurring in the postpartum period: a prospective cohort study. J Clin Psychiatry. 2011;72(11):1531–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Sharma V, Smith A, Khan M. The relationship between duration of labour, time of delivery, and puerperal psychosis. J Affect Disord. 2004;83(2–3):215–20.CrossRefPubMedGoogle Scholar
  41. 41.
    Sharma V. Role of sleep loss in the causation of puerperal psychosis. Med Hypotheses. 2003;61(4):477–81.CrossRefPubMedGoogle Scholar
  42. 42.
    Sandyk R. Postpartum psychosis and the pineal gland. Int J Neurosci. 1992;62(1–2):101–5.PubMedGoogle Scholar
  43. 43.
    Cookson JC. Post-partum mania, dopamine, and estrogens. Lancet. 1982;18 (2 (8299)):672.Google Scholar
  44. 44.
    Lord C, Rieder A, Hall GB, Soares CN, Steiner M. Piloting the perinatal obsessive-compulsive scale (POCS): development and validation. J Anxiety Disord. 2011;25(8):1079–84.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Insight Behavioral Health Centers, Department of PsychiatryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of PsychiatryRush University Medical SchoolChicagoUSA
  3. 3.Wildflower Center for Emotional Health LLCChicagoUSA

Personalised recommendations