Altintas M, Altintas D, Inanc L
Obsessive compulsive disorder emerging in the final trimester of pregnancy: a case report
Pregnancy and postpartum period are periods when psychiatric disorders emerge or exacerbate. These periods are effective in the emergence or the course of OCD. It is reported that OCD is frequent in the third trimester of pregnancy and its characteristics during pregnancy and postpartum are similar. This study will discuss an OCD case starting at 31st week of pregnancy. The woman, aged 32, is married and works as a nurse and has a child aged 4. The patient who sees a blood spot in her uniform washes her uniform immediately after arriving at home, wipes everywhere at home and takes a bath. Then, she starts to worry that diseases such as Hepatitis B, Hepatitis C and AIDS will be transmitted to her from the patients and the vicinity. She reports that hand washing during 36th week of her pregnancy were 50-60 times a day. She runs away from street cats with the fear of contracting rabies. She cannot touch her child, fearing that germ may be transmitted to her child. She sits at a corner at home almost in crinkled position and does not want to get out of bed. She started not to go outside with the fear that germ might be transmitted. She was referred to a psychiatrist with the recommendation of gynecology specialist. Sertraline started to be given to the patient 20 days ago and the dose was increased to 75 mg/day and when sleep withdrawal caused problem 10 days ago, 2.5 mg/day olanzapine was added. It was observed during the examination of her mood that her mood and affection were anxious. It drew attention that she considered a spot on the armchair upholstery to be a blood spot and was afraid and she could not concentrate on the interview and focused on checking the environment. Thoughts that she cannot bear with this situation were dominant in her thought content. She did not have suicide thoughts. Her Y-BOCS score was 30. The patient, who continued pharmacological treatment and had a difficult week because of her obsessions, delivered her baby with caesarean at 37th week. She discontinued her medication, at her own will, since she wanted to breastfeed the infant. Since she experienced an intolerable anxiety 5 days later, she stopped breastfeeding and started to take her medication. When the patient was seen again 2 months after the delivery, 200 mg/day sertraline and 1mg/day risperidone treatment had been gradually started by another doctor. The patient was breastfeeding and was relieved. Her Y-BOCS score was 15. She could take good care of her baby. Her sleep was good. Her anxiety was highly decreased. Hand washing and baths prominently decreased. Her obsessions related to transmittance were partially ongoing. Women should be scanned for OCD in pregnancy and postpartum period. OCD diagnosis should be made in these periods as soon as possible, correct family and patient psychoeducation should be provided, and psychopharmacological treatment and/or psychotherapy should be applied on time.