from bump to baby - university of florida · (kaya et al., 2013, labad et al., 2005; miller et al.,...
TRANSCRIPT
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FromBumptoBaby:PregnancyandPostpartum
ObsessiveCompulsiveDisorder
MeganBarthlePhD,DanielleCookeMS,JosephMcNamaraPhD,KayRoussos-RossMD
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PresentaBonOverview
• Background• ClinicalCare• DisclosureandSelf-Advocacy• ImpactonRelaBonships• QuesBons
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Background
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EpidemiologyofOCSymptoms
• Obsessive-compulsivesymptoms(OCS)arenormalduringpregnancy:– 65%ofthenewparentswhohaveexperiencedarecentbirthreportedobsessionalintrusivethoughts(Abramowitzetal.,2003)
• Longitudinalstudy:• 37.5%ofwomenreportedexperiencingsubclinicalobsessionsorcompulsionsattwoweekspostpartum
• 29.2%at6months(Milleretal.,2013;Milleretal.,2015)
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EpidemiologyofpOCD
• RiskFactorsforpOCD– Higherlevelsofoverallanxiety– HigherlevelsofpreexisBngsubclinicalobsessivecompulsivesymptoms
– PresenceofcogniBvedistorBonssuchasthought-acBonfusion.
(Abramowitzetal.,2003;Abramowitzetal.,2006;Timpanoetal.,2011)
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EpidemiologyofpOCD
• World-widemeta-analysissuggestswomenwhoarepregnantorwhohavegivenbirthare1.79BmesmorelikelytoexperienceOCDthanregionallyandBmematchedwomen– Womenintheprenatalperiodare1.45Bmesmorelikely
– Womeninthepostpartumare2.38Bmesmorelikely
(Russelletal.,2013)
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OnsetAmongPregnant
orPostpartumWomen
Prenatal
%(N)
Postpartum
%(N)
Peripartum
%(N)
ProspecBveSamplesUguzetal.,2007a* 3.9(12)
Milleretal.,2013 5.5(18)
Chaudron&Nirodi,2010* 31.3(5)
RetrospecBveSamplesFairbrotheretal.,2016 2.9(9) 3.6(11) 3.9(12)Uguzetal.,2007b* 0.5(2) *indicatesclinicalinterviewversusself-report
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ExacerbaBonofSymptoms
AmongwomenwithOCDorOCSpriortopregnancy:• Between30-50%willexperienceexacerbaBonofsymptomsduringorfollowingpregnancy
• Between8-20%willexperienceimprovement• Roughly50%willexperiencenochange(Forrayetal.,2010;Guglielmietal.,2014;Labadetal.,2005;Mainaetal.,1997;Uguzetal.,2011;Williams&Koran,1997)
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SymptomType
ChildSafety
Aggressive
Taboo/Unacceptable
Symmetry
ContaminaBon
“I’mafraidthatIcouldgetmybabysick!”
“I’mafraidIwanttohurtmybaby!”
“I’mafraidIwanttomolest
mybaby!”
“I’mafraidifthingsaren’tjustright,mybabywillget
hurt!”
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Depression
• 15-40%ofpostpartumwomenwithOCDexperiencepostpartumdepression(Kayaetal.,2013,Labadetal.,2005;Milleretal.,2013;Williams&Koran,1997;Wenzeletal.,2005;Zambaldietal.,2009).
• PostpartumdepressionandpOCDarecloselylinkedandcanlooksimilarlyclinically(Maurietal.,2010)
– ManywomenwithpostpartumdepressionwillendorseOCS,withsimilarsymptomcontent(Humenik&
Fingerhut,2007;Milleretal.,2013;Wenzel,Gorman,O’Hara&Stuart,2001)
• WomenwithpOCDexperiencesignificantlymoredistress,anxietyanddepressionwhencomparedtocommunitycontrols(Challacombeetal.,2016)
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Partners
• Anxietydisorders(Leach,Poyser,Cooklin,&Giallo,2016)– 4.1-16%prenatal– 2.4-18.0%postpartum
• Depression(Paulson&Bazemore,2010)– 10%postpartum– Highestriskoccurringduringthe3-6monthpostpartumperiod
• RetrospecBvestudies– 2.9%(n=1;Mainaetal.,1999)and6.5%(n=23;Torresanetal.,2013)
• SingleprospecBvestudy(n=726)(Coelhoetal.,2014)– 3.4%inthethirdtrimester– 1.8%duringthepostpartum– 92.3%newonset– maternalOCDstatusmayincreasetherisk(6Bmesmorelikely)
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ClinicalCare
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POCDandCBT-E/RP
• CanbeusedaloneorinconjuncBonwithpsychopharmacologicaltreatment
• EffecBveforpaBentsunwillingtotakemedicaBonsduetoconcernofsideeffectsorcontaminaBon
• BeoerlongtermOCDtreatmentgainswithlessrelapsethanmedicaBonalone(O’Sullivanetal.,1991;Koranetal.,2002)
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POCDandPrevenBon
• AsinglerandomizedcontroltrialsuggeststhatpsychoeducaBonregardingpostpartumanxietyandOCS,treatment,exposuretherapyandcogniBverestructuringcanbeeffecBveinprevenBngvulnerableindividualsfromreachingclinicallevels(Timpanoetal.,2011)
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POCDandFamilyAccommodaBon
• pOCDaffectsparenBngstyle(Abramowitzetal.,2003;Jenningsetal.,1999;Miller&Shah,1999)– Overresponsibleoravoidant
• MostcommonfamilyaccommodaBons(Stewartetal.,2008)– Providingreassurance– WaiBngforritualcompleBon
• FamilyinclusivetreatmentforOCDtargeBngaccommodaBonhasbeenassociatedwithgreaterimprovementinpaBentfuncBoning.(Thompson-Hollandsetal.,2014)
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• UntreatedprenatalOCDissignificantlyassociatedwithpoorqualityoflife(Gezgincetal.,2008)– Impairmentsinphysicalhealth,psychologicalhealth,socialrelaBonshipsandenvironmentquality
• MotherswithOCDreportedlessenjoymentofchildinteracBons,greatermaritaldistress,lesssocialsupport,andlessparenBngconfidencecomparedtocommunitycontrols(Challacombeetal.,2016)
ImpactonRelaBonships
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Medicalcare,PsychopharmacologicalCare,Disclosure,andSelf-Advocacy
AshortvideowithDr.Roussos-Ross
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• CurrentlyrecruiBngcliniciansandresearcherstocompletequalitaBveinterviewsgatheringinformaBontheirperspecBvesonpOCD
• FutureresearchwillinvolveaskingpaBentssimilarquesBonsabouttheirperspecBvesonpOCDtoseewhereclinicianandpaBentperspecBvesconvergeanddiverge
FutureDirecBons