OCD and subliminal OCD are more common in the perinatal period. Easily misdiagnosed, including confusion with delusional symptoms of postpartum psychosis. The clinical features of perinatal obsessive-compulsive disorder are both similar and different from those of other populations. An important feature is that the symptoms often revolve around direct or indirect injury to the infant, which can lead to avoidance and neglect of the infant in severe cases.
The etiology of perinatal OCD is unknown. A history of mood or anxiety disorders, as well as certain personality traits, is currently thought to increase the risk of perinatal obsessive-compulsive disorder. Studies have shown that dysfunction of the stress response system, immune system and neuroendocrine system may be involved in the occurrence of perinatal obsessive-compulsive disorder, but the current evidence is quite limited.
Despite the dangerous nature of the symptoms, unlike postpartum psychosis, women with perinatal OCD rarely actually invade the baby Sexual thoughts are put into practice, and most patients can be properly treated in an outpatient setting. Cognitive behavioral therapy (CBT) with exposure response prophylaxis (ERP), and selective 5-HT reuptake inhibitors (SSRIs) are first-line treatments for perinatal OCD. However, evidence for treatment of some of the unique features of perinatal OCD is still lacking.
The treatment flow chart of perinatal obsessive-compulsive disorder is summarized as follows (click the picture to enlarge):
Notes
▲ The FDA has officially approved fluoxetine, fluvoxamine, paroxetine, sertraline, and clomipramine for the treatment of obsessive-compulsive disorder, all of which can be considered first-line Drugs; there is also limited evidence to support certain second-line treatments, including boosting antipsychotics, and venlafaxine or mirtazapine monotherapy.
▲ Monotherapy should be tried first, and to ensure that the drug has been used to the fullest extent, before considering the combination of a second drug, in order to minimize the types of risks to which the fetus or infant is exposed.
▲ Because obsessive-compulsive disorder itself requires higher doses of antidepressants than mood disorders and anxiety disorders, and the blood concentration will decrease in the third trimester of pregnancy 40%-50%, the dose of antidepressants used by pregnant women at this time may be quite high.
▲ If you can keep pregnant women in good condition without medication, that would be great; but if you can’t, then Effective drug therapy should be initiated decisively, and doses should not be overly conservative. If the dose is not enough, the child will be exposed to both disease and drug risk; with a higher dose to stabilize the mother’s condition, the child will be exposed to less risk.
References: p>
1. Hudepohl N, MacLean JV, Osborne LM. Perinatal Obsessive-Compulsive Disorder: Epidemiology, Phenomenology, Etiology, and Treatment. Curr Psychiatry Rep. 2022 Apr;24(4):229-237. doi: 10.1007/s11920-022-01333-4. Epub 2022 Apr 6. PMID: 35384553.
2. Hutner et al. eds., The APA Textbook of Women’s Reproductive Mental Health (Washington, DC: APA Publishing, 2021)
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