Stress response in postpartum women with and with outobsessive–compulsive symptoms: an fMRI study

Stress response in postpartum women with and with outobsessive–compulsive symptoms: an fMRI study

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J Psychiatry Neurosci 2012;37(2):78-86

Catherine Lord, PhD; Meir Steiner, MD, PhD; Claudio N. Soares, MD, PhD; Caitlin L. Carew, BSc; Geoffrey B. Hall, PHD

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ont.

Abstract

Background: During the postpartum period, some women might be under a considerable amount of stress and at increased risk for on-set or exacerbation of obsessive–compulsive disorder (OCD). Little is known about the stress response correlates during the postpartum period and in patients with OCD. This study aimed to examine the cerebral, psychologic and endocrine correlates of the stress responsein patients with OCD and during the postpartum period.
Methods: Women with postpartum OCD, healthy postpartum women and healthy mothers past the postpartum period underwent functional magnetic resonance imaging while facing a reliable psychosocial stressor (the Montreal Imaging Stress Task). Stress-related psychologic and endocrine responses (i.e., cortisol) were obtained.
Results: We enrolled 12 women with postpartum OCD, 16 healthy postpartum women and 11 healthy mothers past the postpartum period in our study. Compared with healthy postpartum counterparts, postpartum women with OCD had a heightened self-reported and endocrine stress response associated with a distinct brain activation pattern in response to psychosocial stress involving the orbitofrontal and temporal cortices. Moreover, compared with mothers assessed in a period of time beyond the postpartum period, healthy postpartum women did not differ in psychologic and cortisol response to stress, but recruited different brain regions, such as the dorsolateral prefrontal cortex and the anterior cingulate cortex, during exposure to stress.
Limitations: Potential confounding factors, such as medication use, breastfeeding, parity and personality factors, may have modulated the stress-related endocrine response and could not be assessed in this study.
Conclusion: Obsessive–compulsive disorder and the postpartum period differentially influence the brain circuitry underlying psychosocial stress as well as the psychologic and endocrine responses.


Submitted Jan. 17, 2011; Revised May 16, July 8, 17, 2011; Accepted July 26, 2011.

Acknowledgments: We thank Dalia Bibr, Amber Rieder, Carmen McPherson, Patricia Dabek, Dawn Gore, Karen Jansen and Stephanie Bissell for their help with participant recruitment and testing. Thanks to Margaret Coote for her laboratory support and guidance. A special thank you to all the mothers who accepted to participate in the study. Catherine Lord’s involvement in this study was supported by the Fonds de la Recherche en Santé du Québec (FRSQ). Funding for this study was provided by the Wiesz family and Effort Trust.

Competing interests: None declared for C. Lord, C.L. Carew and G.B. Hall. C.N. Soares has received research grants from Eli Lilly, AstraZeneca, Physicians Services Incorporated (PSI) Foundation, Allergen National Centre of Excellence, Hamilton Community Foundation, Lundbeck, Wyeth and the Canadian Institutes of Health Research. He has worked as a research consultant for Wyeth, Pfizer, Lundbeck and Bayer Healthcare Pharmaceuticals; he has participated as a member of the speakers’ bureaus of AstraZeneca, Wyeth, Pfizer, Lundbeck, Bayer Healthcare Pharmaceuticals and as a member of advisory boards for AstraZeneca, Wyeth, Pfizer, Lundbeckand Bayer Healthcare Pharmaceuticals. M. Steiner has received grant/research support from the Canadian Institutes of Health Research, Physicians Services Inc., Wyeth Pharmaceuticals, AstraZeneca, Lundbeck, Eli Lilly, Azevan Pharmaceuticals and Bayer Shering Pharmaceuticals; he is a consultant for Wyeth Pharmaceuticals, Bayer Shering Pharmaceuticals, AstraZeneca, Azevan Pharmaceuticals, Servier and Pfizer; he is a member of the speakers’ bureaus of AstraZeneca and Pfizer.

Contributors: C. Lord, M. Steiner and G.B. Hall designed the study. C. Lord, C.N. Soares C.L. Carew and G.B. Hall acquired and analyzed the data. All authors wrote and reviewed the article and approved its publication.

DOI: 10.1503/jpn.110005

Correspondence to: G.B. Hall, St. Joseph’s Healthcare, Fontbonne Bldg., 301 James St. S, Hamilton ON L8P 3B6; hallg@mcmaster.ca