Specifiers for Depressive Disorders 187
attacks. Prospective studies have demonstrated that mood and anxiety symptoms
during pregnancy, as well as the “baby blues,” increase the risk for a postpartum
major depressive episode.
Peripartum-onset mood episodes can pres ent either with or without psychotic
features. Infanticide is most often associated with postpartum psychotic episodes
that are characterized by command hallucinations to kill the infant or delusions that
the infant is possessed, but psychotic symptoms can also occur in severe postpar-
tum mood episodes without such specific delusions or hallucinations.
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 I 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 long-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-