Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1,000 deliveries and may be more common in primiparous women. The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum mood episodes but is also elevated for those with a prior history of a depressive or bipolar disorder (especially bipolar | disorder) and those with a family history of bipolar disorders.
Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30% and 50%. Postpartum episodes must be differentiated from delirium occurring in the postpartum period, which is distinguished by a fluctuating level of awareness or attention. The postpar- tum period is unique with respect to the degree of neuroendocrine alterations and psychosocial adjustments, the potential impact of breast—feeding on treatment planning, and the Iong-term implications of a history of postpartum mood disorder on subsequent family planning.
With seasonal pattern: This specifier applies to recurrent major depressive disorder.
A. There has been a regular temporal relationship between the onset of major depres- sive episodes in major depressive disorder and a particular time of the year (e.g., in the fall or winter).
Note: Do not include cases in which there is an obvious effect of seasonally related psychosocial stressors (e.g., regularly being unemployed every winter).
B. Full remissions (or a change from major depression to mania or hypomania) also occur at a characteristic time of the year (e.g., depression disappears in the spring).
C. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined above and no nonseasonal major de- pressive episodes have occurred during that same period.
D. Seasonal major depressive episodes (as described above) substantially outnum- ber the nonseasonal major depressive episodes that may have occurred over the individual’s lifetime.
Note: The specifier “with seasonal pattern" can be applied to the pattern of major de- pressive episodes in major depressive disorder. recurrent. The essential feature is the onset and remission of major depressive episodes at characteristic times of the year.
In most cases, the episodes begin in tall or winter and remit in spring. Less commonly, there may be recurrent summer depressive episodes. This pattern of onset and remis- sion of episodes must have occurred during at least a 2-year period. without any non- seasonal episodes occurring during this period. In addition, the seasonal depressive the individual’s lifetime.
This specifier does not apply to those situations in which the pattern is better ex- plained by seasonally linked psychosocial stressors (e.g., seasonal unemployment or school schedule). Major depressive episodes that occur in a seasonal pattern are often characterized by prominent energy, hypersomnia, overeating, weight gain, and a crav- ing for carbohydrates. It is unclear whether a seasonal pattern is more likely in recur- rent major depressive disorder or in bipolar disorders. However, within the bipolar disorders group, a seasonal pattern appears to be more likely in bipolar II disorder than in bipolar | disorder. In some individuals, the onset of manic or hypomanic episodes may also be linked to a particular season.
The prevalence of winter-type seasonal pattern appears to vary with latitude. age, and sex. Prevalence increases with higher latitudes. Age is also a strong predictor of seasonality, with younger persons at higher risk for winter depressive episodes.
Specify it:
In partial remission: Symptoms of the immediately previous major depressive episode are present, but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a major depressive episode following the end of such an episode.
In full remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.
Specify current severity:
Severity is based on the number of criterion symptoms, the severity of those symptoms, and the degree of functional disability.