Wisner K L, Peindl K S, Gigliotti T, Hanusa B H
Women's Services, Mood Disorders Program, Case Western Reserve University, Cleveland, Ohio 44106, USA.
J Clin Psychiatry. 1999 Mar;60(3):176-80. doi: 10.4088/jcp.v60n0305.
The quantity, content, and intensity of the obsessions and compulsions of women with postpartum onset major depressive disorder were compared with those of women with major depressive disorder with non-postpartum onset.
Sequential cases of women with postpartum onset major depression (N = 37) and major depression (N = 28) who presented to our Women's Mood Disorders program were included. Psychiatric examination using DSM-IV criteria and the Inventory to Diagnose Depression established the diagnosis of major depression. Obsessive thoughts and compulsions were reported on the Yale-Brown Obsessive Compulsive Scale and reviewed during the psychiatric examination. Comparisons between groups were performed with chi-square statistics, Fisher exact test and its extensions, and Mann-Whitney U test.
Although more women with postpartum onset major depression (N = 21, 57%) than major depression (N = 10, 36%) reported obsessional thoughts, the difference between the groups was not significant (p = .13). However, for women who endorsed obsessions, those with postpartum onset had a higher median number (median = 7) than women without postpartum onset (median = 2, p = .00). Most of the difference in frequency of thoughts was owing to more women with postpartum onset major depression having aggressive thoughts (N = 20, 95%) than women with major depression (N = 6, 60%, Fisher exact p = .03). The most frequent content of the aggressive thoughts for women with postpartum onset major depression was causing harm to their newborns or infants. The presence or number of obsessional thoughts or compulsions was not related to severity of the depressive episode.
Childbearing-aged women commonly experience obsessional thoughts or compulsions in the context of major depressive episodes. Women with postpartum onset major depression experience disturbing aggressive obsessional thoughts more frequently than women with non-postpartum major depression.
比较产后起病的重度抑郁症女性与非产后起病的重度抑郁症女性的强迫观念及强迫行为的数量、内容和强度。
纳入在我们的女性情绪障碍项目中就诊的产后起病的重度抑郁症患者（N = 37）和重度抑郁症患者（N = 28）的连续病例。采用DSM-IV标准和抑郁诊断量表进行精神检查以确立重度抑郁症的诊断。通过耶鲁-布朗强迫量表报告强迫观念和强迫行为，并在精神检查时进行回顾。采用卡方统计、费舍尔精确检验及其扩展方法以及曼-惠特尼U检验进行组间比较。
虽然报告有强迫观念的产后起病的重度抑郁症女性（N = 21，57%）比重度抑郁症女性（N = 10，36%）更多，但两组之间的差异不显著（p = 0.13）。然而，对于认可有强迫观念的女性，产后起病的女性的中位数（中位数 = 7）高于非产后起病的女性（中位数 = 2，p = 0.00）。思维频率的差异主要是由于产后起病的重度抑郁症女性中有更多的人有攻击性思维（N = 20，95%），而重度抑郁症女性中这一比例为（N = 6，60%，费舍尔精确检验p = 0.03）。产后起病的重度抑郁症女性攻击性思维最常见的内容是对其新生儿或婴儿造成伤害。强迫观念或强迫行为的存在或数量与抑郁发作的严重程度无关。
育龄女性在重度抑郁发作时通常会出现强迫观念或强迫行为。产后起病的重度抑郁症女性比非产后起病的重度抑郁症女性更频繁地经历令人不安的攻击性强迫观念。
