Postpartum obsessive compulsive disorder: a case series.
BACKGROUND
The puerperium has typically been a period of risk for the development of psychiatric illness. Although postpartum depressive illness has been discussed extensively in the literature, obsessive compulsive disorder during pregnancy and puerperium has received little attention.


METHODS
Fifteen women with new-onset obsessive compulsive symptoms during the puerperium were retrospectively evaluated by chart review; all met DSM-III-R criteria for obsessive compulsive disorder. Distinctive features of their clinical presentation, pharmacotherapy received, and status at 1-year follow-up were recorded.


RESULTS
Patients were noted to have a characteristic constellation of symptoms comprised of disabling intrusive obsessional thoughts to harm their babies. Obsessive rituals were not observed in any of the patients described. Patients frequently developed secondary depression and appeared to be exquisitely responsive to serotonin selective reuptake inhibitors.


CONCLUSIONS
The puerperium may be a period of risk for development of new-onset obsessive compulsive disorder. Clinicians caring for puerperal women need to be aware of the impact of these symptoms on maternal and fetal well-being.
Sichel
D A
DA
Department of Psychiatry, Massachusetts General Hospital, Boston 02114.
Cohen
L S
LS
Dimmock
J A
JA
Rosenbaum
J F
JF
D000328:Adult; D002997:Clomipramine / Q000627:therapeutic use; D003891:Desipramine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
D005473:Fluoxetine; D002997:Clomipramine; D003891:Desipramine