Friday, February 23, 2007

Nine Months And Counting....And Counting...

I started this post as an email to Midwife With A Knife to help her with her talk about perinatal psychiatric issues. It got long enough that I decided to turn it into a blog post instead. I see Dinah is also working on her part of MWAK's homework and it's a good one. Here goes.

Last November I went to an excellent CME lecture on perinatal OCD. I thought this would be a nice change from the usual maternity-associated illnesses like post-partum depression and psychosis.

First of all, obessive-compulsive disorder is an anxiety disorder characterized by obsessions or compulsions that are time consuming or interfere with social or occupational functioning.

Obessions are anxiety-producing thoughts, impulses or images that are excessive and beyond the range of normal worry about real-life problems. Sufferers usually recognize that they are irrational, and often try to ignore or suppress them. The most common types of obsessions are contamination obsessions followed by obsessions about aggression or the need for exactness.

Compulsions are urges to perform repetitive behaviors or mental acts. They usually happen in response to obsessions and are aimed at reducing distress or preventing some unpleasant event. The most common types of compulsions are checking rituals followed by cleaning or washing. There can also be mental compulsions (repeating words or numbers, counting or reciting prayers.)

The prevalence of OCD is about 1 in 50 people (2.3% of adults). The gender ratio is 1:1 male/female. The prevalence of perinatal OCD is 0.2 to 3.7%. Eighteen percent of new cases occur during the postpartum and 6% during pregnancy. Most women with pre-existing OCD have no change in symptoms with pregnancy, but one-third may have worsening or a change in symptom presentation.

The types of obsessions in perinatal OCD are different than in non-postpartum OCD. Postpartum obsessions are more likely to involve contamination fears or fears of violence (eg. intrusive thoughts to poke the baby's "soft spot", putting the baby in the microwave) than non-postpartum OCD. Patterns of compulsions are also different---postpartum OCD is more likely to involve checking, washing and cleaning rituals. Some OCD patients have been known to call their daycare multiple times a day to neutralize their obsessions.

About half of women with post-partum depression have co-existing OCD, but the OCD is less likely to be diagnosed because of patient concealment and embarrassment. And yes, fathers can get it too.

Treatment usually involves cognitive-behavioral therapy sometimes combined with medication. For the Ob-Gyn crowd, this would be the time to refer. Dinah is writing a good post about meds in the peripartum, so I'll leave that to her.

Hope this helps.


Dinah said...

I'm no longer Obsessed with the blog, yet still I feel Compelled to leave a comment on ClinkShrink's post.
one two three four, okay gotta go brush my teeth, and wash my hands, and wash my hands, and check the doors, and check the stove;
G'Night all.

Midwife with a Knife said...

Heh heh.

Thank you so much, Clink. :)

In an ironic twist of fate, I actually have an acutely manic (I think, although she could be psychotic or maybe both or maybe did some drugs.... sometimes its hard for me to figure out the difference) pregnant woman on the unit tonight.

I then got to torture some poor sleepy psych resident. I do feel for the guy, but I really don't know what to do with such an acutely psychiatrically ill person. I can obstetrically/ medically clear her, I can make sure the babies' ok, and I can even tell them what drugs they should try to avoid. I can evaluate her and know that I'm useless to her. I just can't come up with a plan.

It's kind of the way my day's been. Busy and weird.

NeoNurseChic said...

"I can evaluate her and know that I'm useless to her."

Hey - that's important!! How often do we see in medicine that doctors try to treat things that are truly outside their domain? As simple as it might sound, it's really a good skill to know when a situation is outside of what you can really tackle.

Take care,
Carrie :)

Sarebear said...

I fight, EVERY night, some compulsions before going to sleep. I often just give in because even when I fight 'em, it most often doesn't make a difference anyway.

Anyhoo, I never knew this could happen in/after pregnancy.

I'll take Dinah's joking in the silly spirit it was intended, instead of taking offense. Just because I struggle with it, doesn't mean I can't take a joke!

Midwife with a Knife said...

Carrie: I don't really feel bad about needing the psych consult; I just felt bad for the psych resident. I was just justifying my getting the psych resident out of bed, poor guy sounded like he just got there. I know from experience how painful it is to be called back to the hospital once you finally manged to get to sleep. But as it turns out, she's in acute renal failure, and seems to have a TTP/HUS like thing going on (Thrombotic Thrombocytopenia Purpura/Hemolytic Uremic Syndrome).

Midwife with a Knife said...

Hey, Clink. Just wanted to say thanks again. I gave my lecture the other day, and your post was really helpful. The anxiety disorder thing was a nice addition. ((Almost?) All pregnant women are anxious, but anxiety disorders present commonly in the reproductive ages, so it is good for Ob-Gyns to be alert for them)

ClinkShrink said...

Cool, I'm glad it went well. It's nice to be useful.