postpartum OCD , poporodni OCD
Večina ljudi pozna poporodno depresijo, bolj malo jih je slišalo za poporodni OCD:
Obsessions: Compulsions:
Fear of contaminating the baby Repeatedly washing the baby
Need for reassurances Repetitively calling the physician
Recurrent fear for the baby’s safety Incessantly checking the baby
Recurrent thoughts of bad mothering Incessantly checking the baby
Recurrent thoughts of harming baby Avoiding or neglecting the baby
“Thoughts of disturbed order” Ordering and rearranging baby’s crib
These feelings and behaviors may occur immediately, but often begin 4 to 6 weeks after giving birth. Treatment is necessary to control symptoms and to ensure care of the baby.
Pregnancy Suspected Trigger in Onset of Obsessive-Compulsive Disorder
LAS VEGAS — April 28, 1997 — The role of obstetricians and gynecologists in recognizing and treating Obsessive-Compulsive Disorder (OCD), an anxiety disorder that may be diagnosed in women following pregnancy, will be discussed at a symposium — Recognizing and Treating and Obsessive-Compulsive Disorder: Opportunities for OB/Gyns — at the American College of Obstetrics and Gynecology annual meeting, April 29 in Las Vegas.
OCD occurs in more than 4 million women and tends to appear in women in their 20s. A biological brain disorder caused by an imbalance of a brain chemical called serotonin, OCD is characterized by obsessive thoughts and compulsive rituals that interfere with daily life.
“In the past, when a mother battled fears of harming her infant, she may have been seen as a nervous new mother who needed hand-holding,” said Kimberly Yonkers, M.D., assistant professor of Psychiatry and Obstetrics and Gynecology, director Reproductive Mood Disorders Program, University of Texas Southwestern Medical Center at Dallas. “But today, healthcare providers are encouraged to view this type of response as a distinct presentation of OCD.”
Signs of postpartum OCD begin in women four to six weeks after giving birth. Patient characteristics include repetitive intrusive thoughts to harm the baby.
“Although OCD has distinct symptoms, it can easily be misdiagnosed, resulting in inappropriate treatment,” said Dr. Yonkers. “By becoming more aware of symptoms and expanding our diagnostic skills, we can function efficiently within new and demanding guidelines.”
Treatment Options
In recent years, healthcare providers have new options to offer patients with OCD. Today, as many as 60 to 65 percent of OCD patients receive benefit from the particular class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. Studies support the possibility that the state of estrogen withdrawal after delivery negatively impacts the serotonin pathway, contributing to the emergence of OCD symptoms. In addition, oxytocin, a hormone produced during pregnancy, may also be a factor in both the worsening of pre-existing OCD and the emergence of the distinct postpartum OCD syndrome.
Impact on Daily Functioning
OCD has a significant impact on daily functioning. Patients with OCD have said that it interferes with family relationships, making and keeping friendships, and can limit academic achievement. In fact it can be even more devastating for women: 65 percent of women with OCD are unemployed, and 12 percent are receiving disability.
Obsessive-compulsive disorder (OCD)
can be a debilitating disorder with the following two anxiety-related essential features:
Obsessions: undesirable, recurrent, disturbing thoughts
Compulsions: repetitive or ritualized behaviors
People with OCD experience unwanted obsessions, which cause anxiety. Severe anxiety produces feelings of dread, worry, fright, and apprehension (see generalized anxiety disorder GAD). Certain behaviors are performed compulsively in an attempt to lessen this anxiety. Although they realize their obsessions are excessive and their behavior is unreasonable, they feel powerless to control either. In fact, their symptoms can overwhelm them and result in severe impairment and dysfunction, which can begin at an early age.
Incidence and Prevalence
The National Institute for Mental Health reports that about 3% of people in the United States have OCD. Typical age of onset for boys is 6 to 15, while for women it is often later, between 20 and 30. Risk factors like genetic predisposition and environmental stress contribute to OCD. Also, OCD is more common among people of higher education, IQ, and socioeconomic status. Men and women, however, are affected equally. Though its course is chronic and usually lasts a lifetime, it is treatable with medication, behavioral therapy, and, in extremely rare cases, brain surgery.
Risk Factors
Risk factors for obsessive-compulsive disorder include the following:
Genetics
Postpartum periods
Environmental stressors
Although there is no clear genetic evidence, obsessive-compulsive disorder tends to run in families. A person with OCD has a 25% chance of having a blood relative who has it. Like other mental illnesses, it is more prevalent among identical twins than fraternal. There is a 70% chance that identical twins with share it, and a 50% chance for fraternal twins. Currently, researchers do not understand OCD’s genetic mechanisms, though they suspect multiple genes are involved.
Women with OCD may experience a worsening of symptoms during pregnancy and postpartum. A recent study suggests that fluctuating hormones may trigger symptoms during pregnancy. The same study reports OCD in 30% of women observed.
The arrival of a baby brings new responsibility, a new set of concerns, and changes in routine. While normal reaction to a newborn may include some anxiety, postpartum OCD features disturbing thoughts and excessive behavior regarding the baby’s well-being. The following obsessions and compulsions are common:
Obsessions: Compulsions:
Fear of contaminating the baby Repeatedly washing the baby
Need for reassurances Repetitively calling the physician
Recurrent fear for the baby’s safety Incessantly checking the baby
Recurrent thoughts of bad mothering Incessantly checking the baby
Recurrent thoughts of harming baby Avoiding or neglecting the baby
“Thoughts of disturbed order” Ordering and rearranging baby’s crib
These feelings and behaviors may occur immediately, but often begin 4 to 6 weeks after giving birth. Treatment is necessary to control symptoms and to ensure care of the baby.
Environmental stressors that can worsen OCD symptoms include the following:
Abuse
Changes in living situation
Illness
Occupational changes or problems
Relationship concerns
School-related problems
Causes
Biological factors involving brain structure and activation are associated with OCD. Abnormalities of the frontal lobes, basal ganglia, and cingulum are common in people with OCD. Basal ganglia are involved in routine behaviors, like grooming, and the frontal lobes in organizing behaviors and in planning. The cingulum consists of fibrous bands that assist in communicating the brain’s behavioral and emotional messages. Support for its role in OCD is the fact that surgical severing of the cingulum has relieved and even cured people with the disorder.
The Serotonin Hypothesis
An abnormally low level of serotonin is perhaps the most well-established link between the brain and OCD. Serotonin is a chemical neurotransmitter that transmits information from one nerve to another throughout the brain. It is released by one synapse(nerve ending), crosses a gap, and is picked up by another synapse. After a message is sent, enzymes in the brain clean serotonin out of the synapses. Drugs used to treat OCD, known as selective serotonin reuptake inhibitors (SSRIs), increase and sustain serotonin levels and reduce or eliminate symptoms (see Treatment).
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