from bump to baby - university of florida · (kaya et al., 2013, labad et al., 2005; miller et al.,...

FromBumptoBaby:PregnancyandPostpartum

ObsessiveCompulsiveDisorder

MeganBarthlePhD,DanielleCookeMS,JosephMcNamaraPhD,KayRoussos-RossMD

PresentaBonOverview

•  Background•  ClinicalCare•  DisclosureandSelf-Advocacy•  ImpactonRelaBonships•  QuesBons

Background

EpidemiologyofOCSymptoms

•  Obsessive-compulsivesymptoms(OCS)arenormalduringpregnancy:– 65%ofthenewparentswhohaveexperiencedarecentbirthreportedobsessionalintrusivethoughts(Abramowitzetal.,2003)

•  Longitudinalstudy:•  37.5%ofwomenreportedexperiencingsubclinicalobsessionsorcompulsionsattwoweekspostpartum

•  29.2%at6months(Milleretal.,2013;Milleretal.,2015)

EpidemiologyofpOCD

•  RiskFactorsforpOCD– Higherlevelsofoverallanxiety– HigherlevelsofpreexisBngsubclinicalobsessivecompulsivesymptoms

– PresenceofcogniBvedistorBonssuchasthought-acBonfusion.

(Abramowitzetal.,2003;Abramowitzetal.,2006;Timpanoetal.,2011)

EpidemiologyofpOCD

•  World-widemeta-analysissuggestswomenwhoarepregnantorwhohavegivenbirthare1.79BmesmorelikelytoexperienceOCDthanregionallyandBmematchedwomen– Womenintheprenatalperiodare1.45Bmesmorelikely

– Womeninthepostpartumare2.38Bmesmorelikely

(Russelletal.,2013)

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

ExacerbaBonofSymptoms

AmongwomenwithOCDorOCSpriortopregnancy:•  Between30-50%willexperienceexacerbaBonofsymptomsduringorfollowingpregnancy

•  Between8-20%willexperienceimprovement•  Roughly50%willexperiencenochange(Forrayetal.,2010;Guglielmietal.,2014;Labadetal.,2005;Mainaetal.,1997;Uguzetal.,2011;Williams&Koran,1997)

SymptomType

ChildSafety

Aggressive

Taboo/Unacceptable

Symmetry

ContaminaBon

“I’mafraidthatIcouldgetmybabysick!”

“I’mafraidIwanttohurtmybaby!”

“I’mafraidIwanttomolest

mybaby!”

“I’mafraidifthingsaren’tjustright,mybabywillget

hurt!”

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)

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)

ClinicalCare

POCDandCBT-E/RP

•  CanbeusedaloneorinconjuncBonwithpsychopharmacologicaltreatment

•  EffecBveforpaBentsunwillingtotakemedicaBonsduetoconcernofsideeffectsorcontaminaBon

•  BeoerlongtermOCDtreatmentgainswithlessrelapsethanmedicaBonalone(O’Sullivanetal.,1991;Koranetal.,2002)

POCDandPrevenBon

•  AsinglerandomizedcontroltrialsuggeststhatpsychoeducaBonregardingpostpartumanxietyandOCS,treatment,exposuretherapyandcogniBverestructuringcanbeeffecBveinprevenBngvulnerableindividualsfromreachingclinicallevels(Timpanoetal.,2011)

POCDandFamilyAccommodaBon

•  pOCDaffectsparenBngstyle(Abramowitzetal.,2003;Jenningsetal.,1999;Miller&Shah,1999)– Overresponsibleoravoidant

•  MostcommonfamilyaccommodaBons(Stewartetal.,2008)– Providingreassurance– WaiBngforritualcompleBon

•  FamilyinclusivetreatmentforOCDtargeBngaccommodaBonhasbeenassociatedwithgreaterimprovementinpaBentfuncBoning.(Thompson-Hollandsetal.,2014)

•  UntreatedprenatalOCDissignificantlyassociatedwithpoorqualityoflife(Gezgincetal.,2008)–  Impairmentsinphysicalhealth,psychologicalhealth,socialrelaBonshipsandenvironmentquality

•  MotherswithOCDreportedlessenjoymentofchildinteracBons,greatermaritaldistress,lesssocialsupport,andlessparenBngconfidencecomparedtocommunitycontrols(Challacombeetal.,2016)

ImpactonRelaBonships

Medicalcare,PsychopharmacologicalCare,Disclosure,andSelf-Advocacy

AshortvideowithDr.Roussos-Ross

•  CurrentlyrecruiBngcliniciansandresearcherstocompletequalitaBveinterviewsgatheringinformaBontheirperspecBvesonpOCD

•  FutureresearchwillinvolveaskingpaBentssimilarquesBonsabouttheirperspecBvesonpOCDtoseewhereclinicianandpaBentperspecBvesconvergeanddiverge

FutureDirecBons