Perinatale Zwangsstörungen

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

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