Abstract
Menstrual psychosis is a rare disorder that causes psychotic symptoms in conjunction with a patient’s menstrual cycle. We present a case of a 14-year-old girl who presents with such symptoms. Our patient presented with five days of somnolence, paranoia, and visual hallucinations soon after a diagnosis of streptococcal pharyngitis and being started on antimicrobial therapy. Her neurologic exam was significant for flat affect and psychomotor slowing. A thorough work-up consisting of brain MRI, EEG, LP, encephalopathy panel, along with metabolic, infectious, and inflammatory laboratory analysis was unremarkable, and she recovered without therapy about one week after symptom onset. Patient had recurrence and spontaneous resolution of her symptoms two more times over the next 10 months with repeat work-up negative; her family noted that the onset of her symptoms always seemed to coincide with the onset of her menses. She was started on combination oral contraceptive pills and has had no further recurrence of her symptoms since then.
Highlights
Menstrual psychosis is a rare diagnosis that has been declining in frequency over the past century
Despite the skepticism surrounding the diagnosis of menstrual psychosis, the role of the menstrual cycle and sex hormones in psychiatric disorders has been clearly demonstrated
The underlying pathophysiology of menstrual psychosis is poorly understood but is thought to be related to the complex hormonal level fluctuations that occur during the menstrual cycle
Summary
Menstrual psychosis is a rare diagnosis that has been declining in frequency over the past century. The patient had another recurrence of her symptoms of somnolence, irritability that started soon after onset of menstrual cramping As this was her third episode and she had complete spontaneous recovery after her previous encounters, her parents elected to watch at home. She was brought into the pediatric hospital two days later when patient started to display signs of possible visual hallucinations when she would wave her hands around in the air. Another thorough work-up, including pelvic MRI, was negative. She was started on combination norethindrone/ethinyl estradiol oral combination contraceptive pills and has had no further recurrence of symptoms since
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