Mental or behavioural disorders associated with pregnancy, childbirth or the puerperium, with psychotic symptoms

Essential Features:

• Onset of a syndrome involving significant mental and behavioural features occurring during pregnancy or the puerperium (i.e., up to about 6 weeks following delivery).
• The syndrome includes psychotic symptoms (i.e., delusions, hallucinations, or other psychotic symptoms). Depressive and/or manic mood symptoms are also typically present.
• The symptoms are not a manifestation of another medical condition (e.g., a brain tumour) and are not due to the effects of a substance or medication on the central nervous system (e.g., benzodiazepines), including withdrawal effects (e.g., from stimulants).
• The disturbance results in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

Note: This diagnosis may be assigned regardless of whether biological factors related to pregnancy, childbirth or the puerperium are known to be etiologically related to the syndrome. If the symptoms meet the diagnostic requirements for a specific mental disorder (e.g., a Mood Disorder, Schizophrenia or Other Primary Psychotic Disorder), that diagnosis should also be assigned. If the symptoms do not meet the diagnostic requirements for a specific mental disorder, the presentation can be described using codes from the section on Mental or Behavioural Symptoms, Signs or Clinical Findings.

Additional Clinical Features:

• Psychotic symptoms in Mental or Behavioural Disorders Associated with Pregnancy, Childbirth or the Puerperium most commonly occur in the context of a Depressive, Manic, or Mixed Mood Episode, in which case a diagnosis of Single Episode Depressive Disorder, Recurrent Depressive Disorder, or Bipolar Type I Disorder should also be assigned.
• Additional symptoms may include confusion and disorientation; sleep disturbance; excessive energy and agitation; obsessions and compulsions; paranoid ideation; and attempts to harm oneself or the baby.

Boundary with Normality (Threshold):

• Psychotic-like symptoms or unusual subjective experiences may occur in the general population, but these are usually fleeting in nature, do not interfere with functioning, and the person is typically aware that they are illusions. Such phenomena should not be diagnosed as Mental or Behavioural Disorders Associated with Pregnancy, Childbirth or the Puerperium.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• This diagnosis may be assigned even if the syndrome represents a recurrence or exacerbation of a pre-existing disorder (e.g., a Mood Disorder, Schizophrenia or Other Primary Psychotic Disorder).