BIPOLAR I DISORDER, POSTPARTUM ONSET
Bipolar I Disorder, is a description of a clinical course which is characterized by the occurrence of one or more manic episode or mixed episodes; often one or more major depressive episode is also found. The disorder is subclassified in the fourth digit of the diagnostic code according to whether the individual is experiencing a first episode or whether it is recurrent; recurrence is indicated by a shift in the polarity of the episode or an interval between episodes of at least two months without manic symptoms. A shift in polarity is defined as a clinical course where a major depressive episode evolves into a manic episode or mixed episode, or where a manic episode or a mixed episode evolves into a major depressive episode. Specifiers used to describe the current episode include: mild, moderate, severe without psychotic features, severe with psychotic features, in partial remission, or in full remission; with catatonic features; and, with postpartum onset. A single episode of Bipolar I Disorder, with mixed features and postpartum onset, would be indicated as 296.0x Bipolar I Disorder, single Manic Episode, Mixed, With Postpartum Onset (DSM-IV, 1994).
Social and obstetric factors have been implicated in the cause of psychosis after childbirth. A stressful life event has been found to be associated with mild postpartum depressive states (Hunt & Silverstone, 1995).
Women who may be at particular risk for postpartum disorders include women with histories of: unipolar depression; pregravid anxiety disorder; bipolar disorder; and a previous puerperal psychosis (Cohen, Sichel, Robertson, Heckscher, & Rosenbaum, 1995).
Bipolar women are at high risk for postpartum episodes. The risk of psychiatric admission within the first thirty days after childbirth has been found to be 21.4 percent for women with manic-depressive illness, manic or circular, and 13.3 percent for women with manic...