Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period.
Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period.
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DOI：
10.4088/jcp.09m05381blu
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发表时间：
2010-08
期刊：
影响因子：
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通讯作者：
Epperson CN
中科院分区：
文献类型：
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作者：
Forray A;Focseneanu M;Pittman B;McDougle CJ;Epperson CN
本研究的主要目的是检查怀孕、分娩和月经对强迫症（OCD）发病和/或强迫症症状加重的影响。126名年龄在18-69岁、符合DSM-IV强迫症标准的大学强迫症门诊妇女，根据DSM-IV障碍的结构化临床访谈进行回顾性访谈，以评估强迫症的发病和症状恶化与生殖事件的关系。女性被分成两组：曾经怀孕（Preg）和从未怀孕（NPreg）。妊娠组进一步细分为报告在围产期发病的强迫症患者（围产期相关，PR）和否认与妊娠有关发病的患者（非围产期相关，NR）。组间比较采用学生t检验进行连续测量，分类变量采用卡方检验进行评估。妊娠组76名妇女中，32.1% （N = 25）在围产期（PR组）发病，15.4%在妊娠期，15.4%在产后，1.3%在流产后发病。在总共132次怀孕中，34.1%的孕妇出现症状加重，22.0%的孕妇出现强迫症症状改善，43.9%的孕妇没有改变已有疾病的症状严重程度。PR组的妇女和围产期已有强迫症恶化的妇女比NR组的妇女更容易出现经前强迫症症状恶化（65.5%比39.3%,p = 0.047）。这项研究的发现提供了额外的证据，证明怀孕和分娩通常与强迫症的发作或已有疾病的症状恶化有关。此外，在整个生殖周期中，强迫症的发病和/或恶化之间似乎存在连续性，至少在月经和怀孕期间是这样。
The primary goal of this study was to examine the impact of pregnancy, childbirth and menstruation on the onset of obsessive-compulsive disorder (OCD) and/or exacerbation of OCD symptoms. One hundred twenty-six women attending a university-based OCD clinic aged 18-69 years who met DSM-IV criteria for OCD according to the Structured Clinical Interview for DSM-IV Disorders were interviewed retrospectively to assess OCD onset and symptom exacerbation in relationship to reproductive events. Women were placed into two groups: ever pregnant (Preg) and never pregnant (NPreg). The Preg group was further subdivided into those who reported onset of OCD in the perinatal period (perinatal-related, PR) and those that denied onset related to pregnancy (non-perinatal-related, NR). Between groups comparisons were done using a Student’s t-test for continuous measures and categorical variables were assessed using the chi-square test. Of the 76 women in the Preg group, 32.1% (N = 25) had OCD onset in the perinatal period (PR group), 15.4% in pregnancy, 15.4% at postpartum, and 1.3% following miscarriage. Out of 132 total pregnancies, 34.1% involved an exacerbation of symptoms, 22.0% involved an improvement in OCD symptoms, and 43.9% did not change symptom severity in women with pre-existing illness. Women in the PR group and women with perinatal worsening of pre-existing OCD were more likely to have premenstrual worsening of OCD symptoms compared to NR women (65.5% vs. 39.3%, p = 0.047). Findings from this study provide additional evidence that pregnancy and childbirth are frequently associated with the onset of OCD or worsening of symptoms in those with pre-existing disorder. In addition, there appears to be continuity between OCD onset and/or exacerbation across the reproductive life cycle, at least with menstruation and pregnancy.