A Case Series of Women With Postpartum-Onset Obsessive-Compulsive Disorder
Primary Care Companion J Clin Psychiatry 1999;1:103-108
© Copyright 2014 Physicians Postgraduate Press, Inc.
Background: There is emerging evidence that
postpartum women are at risk for the development or worsening of
obsessive-compulsive disorder. The purpose of this study was to
provide data regarding the demographics, phenomenology,
associated psychiatric comorbidity, family history, and response
to open treatment with fluvoxamine in subjects with
postpartum-onset obsessive-compulsive disorder.
Method: Seven consecutive subjects were
recruited from an outpatient obstetrical practice and by
advertisement. Subjects completed the Structured Clinical
Interview for DSM-IV, the Yale-Brown Obsessive Compulsive Scale,
and a semistructured interview for family history, demographic
data, and clinical features. Three of the 7 subjects participated
in a 12-week, open-label trial of fluvoxamine treatment of
postpartum-onset DSM-IV obsessive-compulsive disorder.
Results: The women described a mean age at onset
of 28 years, and 4 subjects had a chronic course. Six subjects
reported onset after the birth of their first child, and the mean
time to onset was 3.7 weeks postpartum. All subjects experienced
both obsessions and compulsions and reported aggressive
obsessions that involved their children. None of the subjects
acted on their obsessions to harm the children, but 5 reported
dysfunctional mother-child behavior. All 7 subjects met criteria
for at least 1 comorbid psychiatric disorder, with a mood
disorder the most common. Family histories were notable for high
rates of mood disorders and psychoactive substance use disorders
in first-degree relatives. Two of the 3 subjects who entered the
open-label trial of fluvoxamine experienced a positive response,
defined as a 30% or greater decrease in the total score of the
Yale-Brown Obsessive Compulsive Scale.
Conclusion: Obsessive-compulsive disorder may
present in the postpartum period and become chronic. Symptoms of
the disorder may adversely affect the mother-child relationship,
and it is important to assess for obsessions and compulsions in
postpartum women who present with anxiety and/or depression.
Fluvoxamine may be effective in reducing the symptoms of
postpartum-onset obsessive-compulsive disorder. Controlled
studies are needed to confirm these findings.