Abstract
This chapter begins with a review of the prevalence, assessment, and clinical presentation of anxiety in the perinatal period. Next, we discuss two forms of treatment for anxiety that have been found effective in clinical research: cognitive-behavioral therapy and certain classes of medication. The effectiveness of these treatments with each of the anxiety disorders is discussed, as is the issue of how medication might affect the unborn and breast-feeding infant. Finally, we present a case study of a representative patient with postpartum obsessive-compulsive disorder who was evaluated and treated in our anxiety disorders program.
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References
Cowley, D. S. and Roy-Byrne, P. P. (1989) Panic disorder during pregnancy. J. Psychosom. Obstet. Gynaecol. 10, 193–210.
Elliot, S. A., Rugg, A. J., Watson, J. P., and Brough, D. I. (1983) Mood changes during pregnancy and after the birth of a child. Br. J. Psychiatry 22, 295–308.
Altshuler, L.L., Hendrick, V., and Cohen, L. S. (1998) Course of mood and anxiety disorders during pregnancy and the postpartum period. J. Clin. Psychiatry 59,(Suppl. 2), 29–33.
Shear, K. M. and Mammen, O. (1995) Anxiety disorders in pregnant and postpartum omen. Psychopharmacol. Bull. 31, 693–703.
Birndorf, C. A., Madden, A., Portera, L., et al. (2001) Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients. Int. J. Psychiatry Med. 31, 355–365.
Kelly, R. H., Zatzick, D. F., and Anders, T. F. (2001) The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am. J. Psychiatry 158, 213–219.
Stuart, S., Couser, G., Schilder, K., et al. (1998) Postpartum anxiety and depression: Onset and comorbidity in a community sample. J. Nerv. Ment. Dis. 186, 420–424.
Wenzel, A., Haugen, E. N., Jackson, L. C., and Brendle, J. R. (2005) Anxiety symptoms and disorders at eight weeks postpartum. J. Anxiety Disord. 19, 295–311.
Rapkin, A. J., Mikacich, J. A., Moatakef-Imani, B., and Rasgon, N. (2002) The clinical nature and formal diagnosis of premenstrual, postpartum, and peri-menopausal affective disorders. Curr. Psychiatry Rep. 4, 419–428.
Matthey, S., Barnett, B., Howie, P., and Kavanagh, D. J. (2003) Diagnosing post-partum depression inmothers and fathers: Whatever happened to anxiety ?J. Affect. Disord. 74, 139–147.
Kessler, R. C., McGonagle, K. A., Zhao, S., et al. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch. Gen. Psychiatry 51, 8–19.
Smith, M. V., Rosehheck, R. A., Cavaleri, M. A., et al. (2004) Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetrics clinics. Psychiatr. Serv. 55, 407–414.
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., rev. Washington, DC:, American Psychiatric Association.
Salamero, M., Marcos, T., Gutierrez, F., and Rebull, E. (1994) Factorial study of the BDI in pregnant women. Psychol. Med. 24, 1031–1035.
Wisner, K. L., Peindl, K. S., and Hanusa, B. H. (1996) Effects of childbearing on the natural history of panic disorder with comorbid mood disorder. J. Affect. Disord. 41, 173–180.
Levine, R. E., Oandasan, A. P., Primeau, L. A., and Berenson, A. B. (2003) Anxiety disorders during pregnancy and postpartum. Am. J. Perinatol. 20, 239–248.
Abramowitz, J. S., Schwartz, S. A., Moore, K. M., and Luenzmann, K. R. (2003) Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J. Anxiety Disord. 17, 461–78.
Abramowitz, J. S., Schwartz, S. A., and Moore, K. M. (2003) Obsessional thoughts in postpartum females and their partners: content, severity and relationship with depression. J. Clin. Psychol. Med. Settings 10, 157–164.
Sichel, D. A., Cohen, L. S., Dimmock, J. A., et al. (1993) Postpartum obsessive compulsive disorder: a case series. J. Clin. Psychiatry 54, 156–159.
Rachman, S. J. and de Silva, P. (1978) Abnormal and normal obsessions. Behav. Res. Ther. 16, 233–238.
Jennings, K. D., Ross, S., Pepper, S., et al. (1999) Thoughts of harming infants in depressed and nondepressed mothers. J. Affect. Disord. 54, 21–28.
Wisner, K. L., Peindl, K. S., Gigliotti, T., et al. (1999) Obsessions and compulsions in women with postpartum depression. J. Clin. Psychiatry 60, 176–180.
Ricciardi, J. N. and McNally, R., J. (1995) Depressedmood is related to obsessions but not compulsions in obsessive-compulsive disorder. J. Anxiety Disord. 9, 249–256.
Suri, R. and Burt, V. (1997) The assessment and treatment of postpartum psychiatric disorders. J. Pract. Psychiatry Behav. Health 3, 67–77.
Ayers, S. and Pickering, A. D. (2001) Do women getposttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 28, 111–118.
Cook, C. A. L., Flick, L. H., Homan, S. M., et al. (2004) Posttraumatic stress disorder in pregnancy: prevalence, risk factors and treatment. Obstet. Gynecol. 103, 710–717.
Ballard, C. G., Stanley, A. K., and Brockington, I. F. (1995) Post-traumatic stress disorder (PTSD) after childbirth. Br. J. Psychiatry 166, 525–528.
Geller, P. A., Klier, C.M., and Neugebauer, R. (2001) Anxiety disorders following miscarriage. J. Clin. Psychiatry 62, 432–38.
Frost, M., and Condon, J. T. (1996) The psychological sequelae of miscarriage: a critical review of the literature. Aust. NZ J. Psychiatry 30, 54–62.
Geller, P. A., Kerns, D., and Klier, C. M. (2004) Anxiety following miscarriage and the subsequent pregnancy: a review of the literature and future directions. J. Psychosom. Res. 56, 35–45.
Beck, A. T. (1976) Cognitive Therapy of the Emotional Disorders. New York:, International Universities Press.
Barlow, D. H. (2002) Anxiety and Its Disorders. New York:, Guilford.
Shear, K. and Mammen, O. (1995) Anxiety disorders in pregnant and postpartum women. Psychopharmacol. Bull. 31, 693–703.
Brown, C. S. (2001) Depression and anxiety disorders. Obstet. Gynecol. Clin. North Am. 28, 241–268.
Weisberg, R. B. and Paquette, J. A. (2002) Screening and treatment of anxiety disorders in pregnant and lactating women. Women’s Health Issues 12, 32–36.
McGrath, C., Buist, A., and Norman, T. R. (1999) Treatment of anxiety during pregnancy: effects of psychotropic drug treatment on the developing fetus. Drug Safety 20, 171–186.
Misri, S., Reebye, P., Corral, M., et al. (2004) The use of paroxetine and cognitivebehavioral therapy in postpartum depression and anxiety: arandomized controlled trial. J. Clin. Psychiatry 65, 1236–1241.
Burt, V. K. and Hendrick, V. C. (2005) Clinical Manual of Women’s Mental Health. Washington, DC: American Psychiatric Publishing Inc.
Barlow, D. H., Raffa, S. D., and Cohen, E. M. (2002) Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder. In: Nathan, P. E. and Gorman, J. M., eds. A Guide to Treatments That Work, 2nd ed., New York:, Oxford University Press, pp. 301–335.
Foa, E. B., Franklin, M. E., and Moser, J. (2002) Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? Biol. Psychiatry 52, 987–997.
Westra, H. and Stewart, S. (1998) Cognitive behavioural therapy and pharmaco-therapy: Complementary or contradictory approaches to the treatment of anxiety? Clin. Psychol. Rev. 18, 307–340.
Craske, M. G., Brown, T. A., and Barlow, D. H. (1991) Behavioral treatment of panic disorder: a two-year follow-up. Behav. Ther. 22, 289–304.
Beck, J. G., Stanley, M. A., Baldwin, L. E., et al. (1994) Comparison of cognitive therapy and relaxation training for panic disorder. J. Consult. Clin. Psychol. 62, 818–826.
Abramowitz, J. S. (1996) Variants of exposure and response prevention in the treatment of obsessive compulsive disorder: a meta-analysis. Behav. Ther. 27, 583–600.
Fals-Stewart, W., Marks, A. P., and Schafer, J. (1993) A comparison of behavioral group therapy and individual behavior therapy in treating obsessive-compulsive disorder. J. Nerv. Ment. Dis. 181, 189–193.
Lindsay, M., Crino, R., and Andrews, G. (1997) Controlled trial of exposure and response prevention in obsessive-compulsive disorder. Br. J. Psychiatry 171, 135–139.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., et al. (2005) Treatment of obsessive-compulsive disorder by exposure and ritual prevention, clomipramine, and their combination: a randomized, placebo controlled trial. Am. J. Psychiatry. 162, 151–161.
Freeston, M. H. and Ladouceur, R. (1999) Exposure and response prevention for obsessive thoughts. Cogn. Behav. Pract. 6, 362–383.
Turk, C. L., Heimberg, R. G., and Hope, D. A. (2001) Social anxiety disorder. In: Barlow, D. E., ed., Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, 3rd ed. New York: Guilford Press, pp.114–153.
Resick, P. A. and Calhoun, K. S. (2001) Posttraumatic stress disorder. In: Barlow, D. E., ed. Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, 3rd ed. New York:, Guilford Press, pp. 60–113.
Foa, E., Keane, T., and Friedman, M., eds. (1999) Effective Treatments for PTSD. New York:, Guilford.
Wisner, K. L., Parry, B. L., and Pointek, C. M. (2002) Postpartum depression. N. Engl. J. Med. 347, 194–199.
Boerner, R. and Moeller, H. (1999) The importance of new antidepressants in the treatment of anxiety and depressive disorders. Pharmacopsychiatry 32, 119–126.
Cohen, L. S. and Rosenbaum, J. F. (1998) Psychotropic drug use during pregnancy: weighing the risks. J. Clin. Psychiatry 59,(Suppl. 2), 18–28.
Robinson, L., Walker, J., and Anderson, D.( 1992) Cognitive-behavioral treatment of panic disorder during pregnancy and lactation. Can. J. Psychiatry 37, 623–626.
Altshuler, L., Cohen, L., Szuba, M., et al. (1996) Pharmacologic management of psychiatric illness in pregnancy: dilemmas and guidelines. Am. J. Psychiatry 153, 592–606.
Cohen, L., Sichel, D., Dimmock, J., et al. (1994) Postpartum course in women with preesisting panic disorder. J. Clin. Psychiatry 55, 289–292.
Cowe, L., Lloyd, D., and Dawling, S. (1982) Neonatal convulsions caused by withdrawal from maternal clomipramine. Br. Med. J. 284, 1837–1838.
Misri, S. and Mills, L. (2004) Obsessive-compulsive disorder in the postpartum: open label trial of quetiapine augmentation. J. Clin. Psychopharmacol. 24, 624–627.
Shear, K. M. and Mammen, O. (1995) Anxiety disorders in pregnant and postpartum women. Psychopharmacol. Bull. 31, 693–704.
Burt, V., Suri, R., Altshuler, L., et al. (2001) The use of psychotropic medications during breast-feeding. Am. J. Psychiatry 158, 1001–1009.
Weissman, A. M., Levy, B., Hartz, A., et al. (2004) Pooled analysis of antidepres-sant levels in lactating mothers, breast milk, and nursing infants. Am. J. Psychiatry 161, 1066–1078.
American Academy of Pediatrics Committee on Drugs. (1989) Transfer of drugs and other chemicals into human milk. Pediatrics 84, 924–936.
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Abramowitz, J.S., Larsen, K., Moore, K.M. (2006). Treatment of Anxiety Disorders in Pregnancy and the Postpartum. In: Hendrick, V. (eds) Psychiatric Disorders in Pregnancy and the Postpartum. Current Clinical Practice. Humana Press. https://doi.org/10.1007/978-1-59745-013-3_4
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DOI: https://doi.org/10.1007/978-1-59745-013-3_4
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