Friday, Oct. 28
10:45 – 11:45 (1 hr)
Meeting Room: Birchwood Ballroom (Mezzanine)
Sophie Grigoriadis*, MD; Peggy Richter, MD, FRCPC
- Medical Expert
- Health Advocate
At the end of this session, participants will be able to: 1) Recognize and diagnose peripartum obsessive–compulsive disorder (OCD); 2) Differentiate perinatal OCD from other common major mental health issues arising during pregnancy and the postpartum period; and 3) Appreciate and contrast the risks and benefits of pharmacotherapy and appreciate the role of psychotherapy.
Pregnancy and the postpartum period are recognized as times of heightened vulnerability to psychiatric conditions, such as depressive and anxiety disorders and postpartum psychosis. However, this time period of the life cycle is also marked by the highest risk for onset and exacerbation of obsessive–compulsive disorder (OCD); the prevalence of perinatal OCD has been estimated at about 10% to 17%. OCD developing during this time is typically characterized by fears of contamination, washing or checking, and aggressive intrusive thoughts of harm to the infant. The women are often misdiagnosed, which can lead to serious adverse consequences, including protracted illness, marked distress for the mother and family, and in extreme cases, removal of a child from the home. It is, therefore, critical to improve awareness of perinatal OCD— the diagnosis and management. This workshop will provide a thorough introduction to this issue, including differentiating OCD from other common psychiatric issues presenting during this time period, and review treatment options. The risks of untreated illness, as well as pharmacotherapy, will be covered, in addition to an overview of psychotherapeutic approaches, with a focus on cognitive-behavioural therapy. Workshop material will be contextualized with case vignettes. There will be ample time for discussion, and attendees will have the opportunity to discuss their own cases.
W27a – Treatment Highlights for Obsessive–Compulsive Disorder
Sophie Grigoriadis, MD
At the end of this session, participants will be able to: 1) Identify the potential adverse effects for the mother and fetus or infant of pharmacotherapy for obsessive–compulsive disorder (OCD); 2) Recognize and compare these with the potential adverse effects of untreated OCD; and 3) Demonstrate an understanding of the factors involved in making individual treatment decisions.
Obsessive–compulsive disorder (OCD) can present for the first time or recur during the perinatal period. Treatment follows regular guidelines but consideration for the fetus or child is unique. Because there is concern about possible adverse effects with treatment, weighing the risks and benefits of treatment versus untreated illness is paramount. Pharmacotherapy can include all classes of psychotropics, and potential adverse effects on the fetus, baby, and mother will be reviewed. The aforementioned will be contrasted with potential adverse effects of untreated OCD or anxiety. An overview of psychotherapeutic approaches with a focus on cognitive-behavioural therapy will be included in treatment selection. Treatment decisions are individual and must consider several factors. Workshop material will be contextualized with case vignettes, and attendees are encouraged to bring their own cases for group consideration and discussion. Debate with lively discussion will facilitate consolidating the material. Dr. Grigoriadis is an expert in perinatal treatment and will lead this section.
- Grigoriadis S, Peer M. Antidepressants in pregnancy. In: Uguz F, Orsolini L, editors. Perinatal Psychopharmacology. New York (NY): Springer; 2019. p 69–98.
- Holingue C, Samuels J, Guglielmi V, et al. Peripartum complications associated with obsessive–compulsive disorder exacerbation during pregnancy. J Obsessive Compuls Relat Disord 2021;29:100641.
W27b – Obsessive–Compulsive Disorder Presentations in Perinatal Women
Peggy Richter, MD. FRCPC
At the end of this session, participants will be able to: 1) Elicit harm-related and other taboo thoughts associated with obsessive–compulsive disorder (OCD); 2) Differentiate OCD from other mental health conditions that may be associated with aggressive thoughts; and 3) Discuss evidence-informed pharmacotherapy for perinatal OCD.
Obsessive–compulsive disorder (OCD) can present with a wide range of symptoms, leading to challenges in diagnosis. This problem is often exacerbated when faced with perinatal OCD, as aggressive obsessions are common at this time period. These may include thoughts of inadvertently or deliberately harming the infant, including sexually abusive obsessions. It is imperative the clinician be aware of how to elicit this type of symptomatology and differentiate it from other conditions that can feature similar cognitions, such as depression, postpartum psychosis, and pedophilia. Management of OCD will be reviewed, with a focus on evidence-based pharmacotherapy and how this may be adapted during pregnancy and the postpartum period.
- Veale D, Freeson M, Krebs G, et al. Risk assessment and management in obsessive-compulsive disorder. Adv Psychiatr Treat 2009;15:332–43.
- Uguz F. Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach. Braz J Psychiatry 2015;37:334–42.