Supervisors info:
Ζέρβας Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βαϊδάκης Νικόλαος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γονιδάκης Φραγκίσκος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
A) Retrospective study
The perinatal period is a period of high risk for the onset of OCD but also for the recurrence of pre-existing obsessive compulsive symptoms. The main aim of the research was to identify the type of obsessive compulsive symptoms in the perinatal period in a sample of the Greek population. In the study participated women with OCD diagnosis either pre-existing or perinatal-onset (N = 28). The medical records of these women were reviewed retrospectively, from 2003 to 2017, to investigate the course of the disorder, the comorbidity of other psychiatric disorders, the medication, the signs of incidence and risk factors for the onset of OCD in pregnancy and postpartum. The obsessive compulsive symptoms in the perinatal period were found to be related to the fetus / infant and to be aggression obsessions, contamination obsessions, cleansing / washing compulsions and control compulsions. Pre-existing OCD was present in 42.9% of women and 42.8% perinatal-onset, 21.4% in pregnancy and 21.4% in postpartum. Pre-existing OCD has been predominantly deteriorating in the perinatal period (83.3%), as did pregnancy-onset OCD (50%), while in women with postpartum-onset OCD there was no change (66.7%). Depression and anxiety disorders were the most common comorbid disorders. In terms of medication, the majority of women received selective serotonin reuptake inhibitors, which significantly contributed to the improvement of obsessive compulsive symptoms. Pregnant women with onset of disorder at this stage of life were in their first pregnancy, in the second or third trimester, half of whom had a positive family history of OCD, while the number of births, the history of miscarriage and pregnancy complications were unrelated with pregnancy-onset OCD. In women with postpartum-onset OCD, the onset occurred after the birth of the first child, the first four weeks after childbirth, they had a history of major depression and high levels of anxiety, and almost half had a diagnosis in Axis II, an individual history of obsessive compulsive disorder personality disorder and/or an individual history of avoidance personality disorder.
B) Prospective study
Although Obsessive-compulsive disorder is a heterogeneous clinical entity, there seems to be a consistent pattern regarding the type of obsessive-compulsive symptoms in pregnancy. The aim of the study was to examine the main obsessive compulsive symptoms, the association of subtypes of symptoms with the existence or not of an obsessive-compulsive personality, whether or not coexist with mental disorders and the dysfunctional beliefs in pregnant women with obsessive-compulsive symptoms, regardless of their basic diagnosis. 30 pregnant women were recruited from a psychiatric hospital but also privately and completed a socio-demographic questionnaire, the Obsessive Compulsive Symptom Scale (Y-BOCS), the Obsessive Beliefs Questionnaire (OBQ-44), the Leyton Obsessional Inventory (Leyton trait), the Hospital Anxiety and Depression Scale (HADS) and the Mini International Neuropsychiatric Interview (MINI). The main symptoms were aggression obsessions, and even the fear of intentional or accidental harm to the fetus/infant, contamination obsessions, symmetry/accuracy obsessions, cleansing/washing compulsions, control compulsions and order/settlement compulsions. Pregnant women with obsessive-compulsive personality structure displayed symmetry obsessions and cleansing/washing compulsions as predominant kinds of obsessive-compulsive symptoms, and they also exhibited a greater severity of compulsions than those who did not have an obsessive-compulsive personality. A positive relationship has been found between depression and dysfunctional beliefs and, more specifically, the dysfunctional belief of the increased responsibility/ overestimation of the threat. The results of the logistic regression model suggest that the dysfunctional belief of importance/control of thoughts predicted the aggression obsessions, the belief of increased responsibility/overestimation of threat predicted three kinds of obsessive-compulsive symptoms, contamination obsessions, cleansing /washing compulsions and order/settlement compulsions, the belief of perfectionism/intolerance to uncertainty did not predict a certain dimension of obsessive compulsive symptoms, and most of the observed associations between dysfunctional beliefs and obsessive-compulsive symptoms remained after control of anxiety and depression. Pregnant women with obsessive-compulsive and depressive symptoms had aggression obsessions, cleaning/washing compulsions and control compulsions and the obsessive-compulsive symptoms were more serious, while in pregnant women without depression, dominated the religious obsessions, and more specifically there were references to sins. In pregnant women with obsessive-compulsive and anxiety symptoms, contamination obsessions and cleaning/washing compulsions have been found, with no difference in the severity of obsessive-compulsive symptoms in women with or without anxiety, but when there were no symptoms of anxiety, then dominated religious obsessions and order/settlement compulsions.
Keywords:
Obsessive-compulsive symptoms, Pregnancy, Obsessive-compulsive personality structure, Dysfunctional beliefs, Comorbidity, Anxiety, Depression, Obsessive-compulsive disorder, Perinatal period, Symptom dimensions, course of disorder, Medication, Signs of incidence and risk factors
