The New England Journal of MedicineCase 24-2024: A 30-Year-Old Woman with Postpartum Anxiety and Intrusive Thoughts

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This case study of a 30-year-old woman with postpartum anxiety and intrusive thoughts highlights the complex presentation and management of postpartum obsessive-compulsive disorder (OCD). The article emphasizes the importance of accurate diagnosis, appropriate treatment, and the challenges in providing comprehensive care for new mothers experiencing mental health issues in the peripartum period.

Key Points:

• Postpartum psychiatric illness is one of the most common complications of childbirth, with risk factors including personal history of psychiatric illness, primiparity, and family history of psychiatric illness.
• Postpartum OCD is characterized by intrusive thoughts, often focused on infant harm, accompanied by compulsive behaviors such as constant checking on the infant’s well-being.
• Treatment for postpartum OCD typically involves a combination of cognitive behavioral therapy (CBT) with exposure and response prevention therapy, and pharmacological interventions, primarily selective serotonin reuptake inhibitors (SSRIs).
• Higher doses of SSRIs may be required for effective treatment of postpartum OCD compared to standard dosages for depression.
• Obstetrical clinicians play a crucial role in screening for and initiating treatment of peripartum mental health conditions, but face challenges in providing comprehensive care due to limited training and resources.
• Integrated behavioral health models, such as the collaborative care model, can improve access to specialized mental health care for postpartum patients.
• Universal screening for both depression and anxiety symptoms is recommended for peripartum patients to ensure timely diagnosis and treatment.

“The treatment of postpartum OCD involves understanding the necessity of mitigating the torment for patients having egodystonic intrusive thoughts that frequently focus on the possibility of causing harm to the newborn or having paralyzing thoughts regarding the well-being of the infant.”

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