Zusammenfassung
Unter einer perinatalen Zwangsstörung versteht man die Erstmanifestation bzw. Exazerbation von Zwangssymptomen während einer Schwangerschaft und/oder post partum. Über die Häufigkeit von Zwangsstörungen in der allgemein für psychische Erkrankungen als vulnerabel geltenden perinatalen Phase gibt es kaum verlässliche Daten. Klinisch überwiegen bei der eher multifaktoriell bedingten perinatalen Zwangsstörung Zwangsgedanken und Zwangshandlungen, die im Zusammenhang mit der Sorge um das Wohl des Ungeborenen bzw. Neugeborenen stehen. Eine differenzialdiagnostische Abgrenzung gegenüber Schwangerschaftspsychosen und postpartalen Depressionen ist oft schwierig. Bei der Behandlung sollten nicht medikamentöse Strategien bevorzugt werden und der Einsatz der SSRIs sollte streng indiziert erfolgen. Insgesamt jedoch liegen zu perinatalen Zwangsstörungen kaum kontrollierte Untersuchungen vor und das Wissen über diese spezielle Patientengruppe ist eher als gering einzustufen. Ziel dieser Übersichtsarbeit ist es, die perinatale Zwangsstörung hinsichtlich Phänomenologie, Pathogenese, Differenzialdiagnostik und Therapiemaßnahmen näher darzustellen. Ein frühzeitiges Erkennen und Einleiten von Therapiemaßnahmen erscheint von großer Bedeutung für den Aufbau einer guten und längerfristig stabilen Mutter-Kind-Beziehung zu sein.
Abstract
A perinatal obsessive-compulsive disorder (OCD) is defined as an illness exhibiting first symptoms in the context of pregnancy and the postpartal period. There are no valid data up to date concerning the incidence of OCD, which might be of multifactorial origin, in this period in which females are highly vulnerable for psychiatric diseases. From a clinical point of view, obsessions and compulsions are mainly related to the well-being of the foetus or newborn baby. Differential diagnosis of perinatal OCD including pregnancy psychosis and post-partum depression is often difficult. Concerning treatment, non-pharmacological approaches should be preferred. Administration of SSRIs should be strongly restricted. However, there are no controlled therapy studies in patients with perinatal OCD. Furthermore, current knowledge about these patients is still limited. The aim of this review article is the presentation of phenomenology, pathogenesis, differential diagnosis and treatment of perinatal OCD. The mental situation of the female patients can be improved and stabilised if early diagnosis of a perinatal OCD leads to early initiation of an adequate therapy. This will then enable a good and stable mother-child relationship to develop.
Schlüsselwörter
Zwangsstörung - Schwangerschaft - Postpartum
Keywords
obsessive-compulsive disorder - pregnancy - postpartum period
Literatur
-
1 Zaudig M. Epidemiologie, Komorbidität und Verlauf der Zwangsstörung. In: Zaudig M, Hauke W, Hegerl U, Hrsg Die Zwangsstörung, Diagnostik und Therapie. 2. Aufl. Stuttgart: Schattauer; 2002: 33-39
-
2
Ross L E, McLean L M.
Anxiety disorders during pregnancy and the postpartum period: a systematik review.
J Clin Psychiatry.
2006;
67
1285-1298
-
3
Neziroglu F, Anemone R, Yaryura-Tobias J A.
Onset of obsessive-compulsive disorder in pregnancy.
Am J Psychiatry.
1992;
149
947-950
-
4
Williams K E, Koran L M.
Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum.
J Clin Psychiatry.
1997;
58
330-334
-
5
Abramowitz J S, Schwartz S A, Moore K M et al.
Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature.
J Anxiety Disorders.
2003;
17
461-478
-
6
Kalra H, Tandon R, Trivedi J K et al.
Pregnancy-induced obsessive compulsive disorder: a case report.
Annals of Generaly Psychiatry.
2005;
4
1-3
-
7
Uguz F, Gezginc K, Zeytinci I E et al.
Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy.
Comprehensive Psychiatry.
2007;
48
441-445
-
8
Uguz F, Gezginc K, Kayhan F et al.
Is pregnancy associated with mood and anxiety disorders? A cross-sectional study.
Gen Hosp Psychiatry.
2010;
32
213-215
-
9
Forray A, Fosseneanu M, Pittman B et al.
Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period.
J Clin Psychiatry.
2010;
71
1061-1068
-
10
Sichel D A, Cohen L S, Dimmock J A et al.
Postpartum obsessive compulsive disorder: a case series.
J Clin Psychiatry.
1993;
54
156-159
-
11
Arnold L M.
A case series of women with postpartum-onset obsessive-compulsive disorder.
Prim Care Companion J Clin Psychiatry.
1999;
1
103-108
-
12
Labad J, Menchon J M, Alonso P et al.
Female reproductive cycle and obsessive-compulsive disorder.
J Clin Psycchiatry.
2005;
66
428-435
-
13
Zambaldi C F, Cantilino A, Montenegro A C et al.
Postpartum obsessive-compulsive disorder:prevalence and clinical characteristics.
Comprehensive Psychiatry.
2009;
50
503-509
-
14 Niedermeier N, Zaudig M. Definition und Beschreibung der Zwangsphänomene. In: Zaudig M, Hauke W, Hegerl U, Hrsg Die Zwangsstörung, Diagnostik und Therapie. 2. Aufl. Stuttgart: Schattauer; 2002: 1-11
-
15
Brockington I F, Macdonald E, Wainscott G.
Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium.
Arch Womens Ment Health.
2006;
9
253-263
-
16
Martini J, Wittchen H U, Soares C N et al.
New women-specific diagnostic modules: the Composition International Diagnostic Interview for Women (CIDI-VENUS).
Arch Womens Ment Health.
2009;
12
281-289
-
17
Austin M P.
Classification of mental health disorders in the perinatal period: future directions for DSM-V and ICD-11.
Arch Womens Ment Health.
2010;
13
41-44
-
18 Mavrogiorgou P, Juckel G. Depressive Störungen im Rahmen des weiblichen Zyklus und der Schwangerschaft. In: Hegerl U, Hoff P, Hrsg. Depressionsbehandlung unter komplizierenden Bedingungen.. Bremen: Uni-Med; 2003: 76-88
-
19
Leung B M, Kaplan B J.
Perinatal depression: prevalence, risks, and the nutrition link - a review of the literature.
J Am Diet Assoc.
2009;
109
1566-1575
-
20
Lancaster C A, Gold K J, Flynn H A et al.
Risk factors for depressive symptoms during pregnancy: a systematic review.
Am J Obstet Gynecol.
2010;
202
5-14
-
21
Riecher-Rössler A.
Psychische Störungen und Erkrankungen nach der Entbindung.
Fortschr Neurol Psychiat.
1997;
65
97-107
-
22
Watkins M E, Newport D J.
Psychosis in pregnancy.
Obstet Gynecol.
2009;
113
1349-1353
-
23
Van Mullen C, Tillet J.
Psychiatric disorders in pregnancy.
J Perinatal Neonatal Nurs.
2009;
23
124-130
-
24
Kendell R E, Chalmers J C, Platz C.
Epidemiology of puerperal psychoses.
Brit J Psychiat.
1987;
150
662-673
-
25
Jones I, Heron J, Blackmore E R et al.
Incidence of hospitalization for postpartum psychotic and bipolar episodes.
Arch Gen Psychiatry.
2008;
65
356
-
26
Spinelli M G.
Postpartum psychosis: detection of risk and management.
Am J Psychiatry.
2009;
166
405-408
-
27
Sharma V, Khan M.
Identification of bipolar disorder in women with postpartum depression.
Bipolar Disord.
2010;
12
335-340
-
28
Doucet S, Dennis C L, Letourneau N et al.
Differentiation and clinical implications of postpartum depression and postpartum psychosis.
J Obstet Gynecol Neonatal Nurs.
2009;
38
269-279
-
29
Bergink V, Koorengevel K M.
Postpartum depression with psychotic features.
Am J Psychiatry.
2010;
167
476-477
-
30
Wisner K, Moses-Kolko E L, Sit D KY.
Postpartum depression: a disorder in search of a definition.
Arch Womens Ment Health.
2010;
13
37-40
-
31
Abramowitz J S, Meltzer-Brody S, Leserman J et al.
Obsessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms.
Arch Womens Ment Health.
2010;
DOI: 10.1007 /s00737-010-0172-4
-
32
Friedman S H, Resnick P J.
Postpartum depression: an update.
Womens Health.
2009;
5
287-295
-
33
Sichel D A, Cohen L S, Rosenbaum J F et al.
Postpartum onset of obsessive-compulsive disorder.
Psychosomatics.
1993;
34
277-279
-
34
Wisner K L, Peindl K S, Gigliotti T et al.
Obsessions and compulsions in women with postpartum depression.
J Clin Psychiatry.
1999;
60
176-180
-
35
Wenzel A, Haugen E N, Jackson L C et al.
Anxiety symptoms and disorders at eight weeks postpartum.
J Anxiety Disord.
2005;
19
295-311
-
36
Navarro P, Garcia-Esteve L, Ascaso C et al.
Non-psychotic psychiatric disorders after childbirth: prevalence and comorbidity in a community sample.
J Affect Disord.
2008;
109
171-176
-
37
Voderholzer U.
Obsessive-compulsive disorders.
Fortschr Neurol Psychiatr.
2005;
73
526-542
-
38
Zurowski B, Hohagen F, Kordon A.
Neurobiologie der Zwangsstörung. Teil 1: Konzepte zur Pathophysiologie und Genetik.
Nervenheilkunde.
2009;
9
625-630
-
39
Zurowski B, Hohagen F, Kordon A.
Neurobiologie der Zwangsstörung. Teil 2: Konzepte und Befunde aus der Neurobildgebung.
Nervenheilkunde.
2009;
11
809-816
-
40
Lasiuk G C, Hegadoren K M.
The effects of estradiol on central serotonergic systems and its relationship to mood in women.
Biol Res Nurs.
2007;
9
147-160
-
41
Rybaczyk L A, Bashaw M J, Pathak D R et al.
An overlooked connection: serotonergic mediation of estrogen-related physiology and pathology.
BMC Womens Health.
2005;
20
5-12
-
42
Amin Z, Canli T, Epperson C N.
Effect of estrogen-serotonin interactions on mood and cognition.
Behav Cogn Neurosci Rev.
2005;
4
43-58
-
43
Ladisich W.
Influence of progesterone on serotonin metabolism: a possible causal factor for mood changes.
Psychoneuroendokrinology.
1977;
2
257-266
-
44
Le Melledo J M, Baker G.
Role of progesterone and other neuroactive steroids in anxiety disorders.
Expert Rev Neurother.
2004;
4
851-860
-
45
Den Boer J A, Westenberg H G.
Oxytocin in obsessive-compulsive disorder.
Peptides.
1992;
13
1083-1085
-
46
Leckman J F, Goodman W K, North W G et al.
Elevated cerebrospinal fluid levels of oxytocin in obsessive-compulsive disorder. Comparison with Tourette`s syndrome and healthy controls.
Arch Gen Psychiatry.
1994;
51
82-92
-
47
Marazziti D, Catena Dellòsso M.
The role of oxytocin in neuropsychiatric disorders.
Curr Med Chem.
2008;
15
698-704
-
48
Altemus M, Jacobson K R, Debellis M et al.
Normal CSF oxytocin and NPY levels in OCD.
Biol Psychiatry.
1999;
45
931-933
-
49
Epperson C N, McDougle C J, Price L H.
Intranasal oxytocin in obsessive-compulsive disorder.
Biol Psychiatry.
1996;
40
547-549
-
50
Altemus M, Pigott T, Kalogeras K T et al.
Abnormalities in the regulation of vasopressin and corticotropin releasing factor secretion in obsessive-compulsive disorder.
Arch Gen Psychiatry.
1992;
49
9-20
-
51
Kluge M, Schüssler P, Künzel H E et al.
Increased nocturnal secretion of ACTH and cortisol in obsessive-compulsive disorder.
J Psychiatry Res.
2007;
41
928-933
-
52
Gustafsson P E, Gustafsson P A, Ivarsson T et al.
Diurnal cortisol levels and cortisolresponse in youths with obsessive-compulsive disorder.
Neuropsychobiology.
2007;
57
14-21
-
53
Brunton P J, Russel J A.
The expectant brain: adapting for motherhood.
Nature Rev Neuroscience.
2008;
9
11-25
-
54
Vasconcelos M S, Sampaio A S, Hounie A G et al.
Prenatal, Perinatal, and postnatal risk factors in obsessive-compulsive disorder.
Biol Psychiatry.
2007;
61
301-307
-
55
Leckman J F, Mayes L C, Feldman R et al.
Early parental preoccupations and behaviors and their possible relationship to the symptoms of obsessive-compulsive disorder.
Acta Psychiatr Scand Suppl.
1999;
398
1-26
-
56
Fairbrother N, Abramowitz J S.
New parenthood as a risk factor for the development of obsessional problems.
Beh Res Ther.
2007;
45
2155-2163
-
57
Mowrer O H.
On the dual nature of learning-a re-interpretation of „conditioning and „problem solving”.
Harvard Educational Review.
1947;
17
102-148
-
58 Niedemeier N, Bossert-Zaudig S. Psychologische Modelle zur Erklärung der Entstehung und Aufrechterhaltung von Zwangsstörungen. In: Zaudig M, Hauke W, Hegerl U, Hrsg. Die Zwangsstörung, Diagnostik und Therapie. 2. Aufl. Stuttgart: Schattauer; 2002: 65-72
-
59
Salkovskis P, Forrester E, Richards C.
Cognitive-behavioral approach to understanding obsessional thinking.
Br J Psychiatry.
1998;
35
53-63
-
60
Varkukla M, Viguera A C, Gonsalves L.
Depression and pregnancy.
Compr Ther.
2009;
35
44-49
-
61 Hegerl U, Mavrogiorgou P. Biologische Grundlagen von Zwangsstörungen. In: Zaudig M, Hauke W, Hegerl U, Hrsg Die Zwangsstörung, Diagnostik und Therapie. 2. Aufl Stuttgart: Schattauer; 2002: 43-63
-
62
Brüne M.
The evolutionary psychology of obsessive-compulsive disorder. The role of cognitive metarepresentation.
Perspectives in Biology and Medicine.
2006;
49
317-329
-
63
Mataix-Cols D, do Rosario-Campos M C, Leckman J F.
A multidimensional model of obsessive-compulsive disorder.
Am J Psychiatry.
2005;
162
228-238
-
64
Leckman J F.
An evolutionary and developmental perspective.
Biol Psychiatry.
2007;
62
831-832
-
65
Saad G.
sex differences in OCD symptomatology: an evolutionary perspective.
Medical Hypotheses.
2006;
67
1455-1459
-
66
Brandes M, Soares C N, Cohen L S.
Postpartum onset obsessive-compulsive disorder: diagnosis and management.
Arch Womens Ment Health.
2004;
7
99-110
-
67
Misri S, Milis L.
Obsessive-compulsive disorder in the postpartum: open-label trial of quetiapine augmentation.
J Clin Psychopharmacol.
2004;
24
624-627
-
68
Marazziti D, Consoli G.
Treatment strategies for obsessive-compulsive disorder.
Exp Opin Pharmacother.
2010;
11
331-343
-
69
Tschudin S, Lapaire O.
Antidepressiva in der Schwangerschaft.
Therapeutische Umschau.
2005;
62
17-22
-
70
Källen B A, Olausson P O.
Maternal use of selective reuptake inhibitors in early pregnancy and infant congenital malformations.
Birth Defects Res A Clin Mol Teratol.
2007;
79
301-308
-
71
Alwan S, Friedman J M.
Safety of selective serotonin reuptake inhibitors in pregnancy.
CNS Drugs.
2009;
23
493-509
-
72
Tuccori M, Testi A, Antonioli L et al.
Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: a review.
Clin Ther.
2009;
31
1426-1453
-
73
Toh S, Mitchell A A, Loik C et al.
Antidepressant use during pregnancy and the risk of preterm delivery and fetal growth restriction.
J Clin Psychopharmacol.
2009;
29
555-560
-
74
Källen B, Olausson P O.
Maternal use of selective serotonin reuptake inhibitors and persistent pulmonary hypertension of the newborn.
Pharmacoepidemiol Drug Saf.
2008;
17
801-806
-
75
Warburton W, Hertzman C, Oberlander T F.
A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health.
Acta Psychiatr Scand.
2010;
121
471-479
-
76
Nulman I, Rovet J, Stewart D E et al.
Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study.
Am J Psychiatry.
2002;
159
1889-1895
-
77
Iqbal M M, Sobhan T, Aftab S R et al.
Diazepam use during pregnancy: A review of the literature.
Del Med Jrl.
2002;
74
127-134
-
78
Freeman M P.
Breastfeeding and antidepressants: Clinical dilemmas and expert perspectives.
J Clinic Psychiatry.
2009;
70
291-292
Dr. Paraskevi Mavrogiorgou
Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum
Alexandrinenstr.1
44791 Bochum
Email: paraskevi.mavrogiorgou-juckel@wkp-lwl.org
