Specifiers for Mood Disorders

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Specifiers allow for a more specific diagnosis, which assists in treatment and prognosis. A postpartum onset specifier can be applied to a diagnosis of major depressive disorder or bipolar I or II disorder if the onset is within four weeks after childbirth. Symptoms include fluctuations in mood and intense (sometimes delusional) preoccupation with infant well-being. Severe ruminations or delusional thoughts about the infant are correlated with increased risk of harm to the infant. The mother may be uninterested in the infant, afraid of being alone with the infant, or may even try to kill the child while experiencing auditory hallucinations instructing her to do so or delusions that the child is possessed. Postpartum mood episodes severely impair functioning, which differentiates them from the "baby blues"

that affects about 70 percent of women within ten days after birth.

Seasonal pattern specifier can be applied to bipolar I or II disorder or major depressive disorder. Occurrence of major depressive episodes is correlated with seasonal changes. In the most common variety, depressive episodes occur in the fall or winter and remit in the spring. The less common type is characterized by depressive episodes in the summer. Symptoms include lack of energy, oversleeping, overeating, weight gain, and carbohydrate craving. Light therapy, which uses bright visible-spectrum light, may bring relief to patients with a seasonal pattern to their mood disorder.

The rapid cycler specifier can be applied to bipolar I or II disorder. Cycling is the process of going from depression to mania, or hypomania, and back or vice versa. Cycles can be as short as a few days or as long as months or years. Rapid cycling involves the occurrence of four or more mood episodes during the previous twelve months. In extreme cases, rapid cyclers can change from depression to mania and back or vice versa in as short as a few days without a normal mood period between episodes. Seventy to ninety percent of rapid cyclers are both premenopausal and postmenopausal women. Rapid cycling is associated with a poorer prognosis.

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