Diagnosis Of Premenstrual Dysphoric Disorder Research Articles

Associated Factors with Premenstrual Dysphoric Disorder among Undergraduate Medical Students of a Teaching Hospital

Introduction: Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome in women which adversely affects social, academic, or work performance. The mechanisms underlying PMDD are still insufficiently known, the findings indicate a multifactorial genesis. Prevalence data of PMDD and its potential associated risk factors is sparse in Nepal. This study aimed to determine the associated factors with PMDD among undergraduate medical students of a teaching hospital in Nepal. Methods: This was a cross sectional study conducted among unmarried female medical students at KIST medical college and teaching hospital from 1st June to 30th July, 2023. Students were assigned from each of the four MBBS years (First, Second, Third, and Final) through random sampling till the desired sample size was achieved. Questionnaires about socio-demographic, menstrual, lifestyle variables and questionnaire for diagnosis of PMDD were administered. PMDD was diagnosed from the Diagnostic and Statistical Manual – fifth edition (DSM-5) of the American Psychiatric Association (APA). Data Analysis was performed using SPSS version 16. Data calculated as frequencies, mean, standard deviation and chi square test, independent t test with p-value of < 0.05 was considered as statistically significant. Results: The prevalence of PMDD according to DSM-V criteria was 41 (36.28%). PMDD was significantly associated with dysmenorrhea (P=0.030) and with intake of caffeinated beverages (P=0.034). Conclusion: PMDD is prevalent among medical students in Nepal. The potential associated risk factors are dysmenorrhea and intake of caffeinated beverages.

#5 : Associated Factors with Premenstrual Syndrome and Premenstrual Dysphoric Disorder Among Female Medical Students: A Cross-Sectional Study

Background and Aims: Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD) are two premenstrual disorders that have been reported in many countries and have gradually become predominant concerns The study aimed to determine potential risk factors associated with PMS and PMDD Method: Three hundred two female student participants who were 18 – 45 years old completed a questionnaire including demographic characteristics, lifestyle factors, and a Vietnamese Premenstrual Syndrome Screening Tool (PSST). We then followed up participants during at least two menstrual cycles using the Daily Record of Severity of Problems (DRSP). The PMS and PMDD diagnosis were established using The Carolina Premenstrual Assessment Scoring System (C-PASS), based on the American College of Obstetrics and Gynecology (ACOG) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Results: According to the C-PASS, 35 out of 302 students (11.6%; 95%CI: 8.2-15.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). We found that age at menarche (PR = 0.77, 95%CI: 0.63 - 0.96), having negative Rh blood type (PR=4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR=2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having PMS/PMDD after adjusting for other variables. Conclusion: The prominent risk factors for PMS and PMDD were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression.

Current Practical Progress and Dilemmas in the Study of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PPD) refers to a range of symptoms which are related to the menstrual cycle, which is not only accompanied by severe physical symptoms, but often by severe emotional symptoms as well. This can have a serious impact not only on the patient's daily life, but also on the social costs. To date, however, the etiology of this disorder is not well understood and there are not very accurate, objective diagnostic methods or universally applicable special treatment options. This article aims to summaries some of the research literature relating to the etiology, diagnosis and treatment of PPD, over the last approximately 15 years, with a view to providing some insight into future research on PDD. The etiology of PDD may be related to 5-HT, GABAergic dysregulation and abnormal response of GABAA receptors to allopregnanolone. PDDs diagnosis relies primarily on a number of scale assessments and information from medical history and physical examination. Common first and second line treatment options are antidepressants and oral contraceptives (OCs) respectively. Symptoms of PDD can also be reduced with some psychosocial treatment.

The Effect of Premenstrual Dysphoric Disorder Diagnosis and Severity on Depression Sensitivity.

Premenstrual dysphoric disorder (PMDD) is thought to be associated with depressive disorder. In our study, the depression susceptibility of female patients with PMDD was assessed using the depression sensitivity scale, which is different from previous studies. The study was conducted on 32 PMDD patients aged 18-40 years who applied to the psychiatry outpatient clinic and 30 healthy controls. The mean age of women diagnosed with PMDD was similar ( p = 0.467). The probability of having a family history of PMDD was significantly higher in the PMDD group than in the control group (χ 2 = 11.182, p = 0.001). Previous psychotropic drug use (χ 2 = 8.862, p = 0.003) and family history of mental illness (χ 2 = 5.995, p = 0.014) were significantly higher in PMDD patients compared with the control group. The sociodemographic questionnaire, the Leiden Index of Depression Sensitivity (LEIDS), and the Premenstrual Assessment Form were administered to the participants. No significant difference was found between the patient and healthy groups regarding LEIDS scores ( r = 0.75, p > 0.05). In patients with PMDD, the clinical severity of PMDD was found to increase susceptibility to depression ( r = 0.460, p < 0.01). It was revealed that PMDD severity was associated with susceptibility to depression rather than PMDD diagnosis.

Trouble dysphorique prémenstruel : prises en charge médicamenteuses et psychothérapeutiques, une revue de littérature

IntroductionPremenstrual Dysphoric Disorder (PMDD) was first recognised in July 2013 in the DSM-5 after a long journey to identify its existence. It was not until 1983 that the US National Institute of Mental Health determined research criteria for the study of PMS. In 1994, the term “premenstrual dysphoric disorder” (PMDD) replaced this term in the 4th edition of the Diagnostic System Manual (DSM). It was listed in the section “Mood Disorder Not Otherwise Specified” and remained under consideration until the DSM-5, in which it appeared in the depressive disorders section. The legitimisation of the psychiatric diagnosis as well as the determination of clear symptomatology criteria in 2013 opened up possibilities for management, development of clinical, pathophysiological, therapeutic and psychotherapeutic studies. This disabling disorder can affect personal, social, family and professional life. In 2019, the ICD-11 in turn introduced the diagnosis of premenstrual dysphoric disorder, which solidifies the recognition of the disorder. Objective(I) to review the existing treatments, both medicinal and psychotherapeutic, and (II) to review their effectiveness. At the end of this work we will formulate recommendations for the management of these patients. MethodologyA bibliographic search was carried out from 7 June 2021 to 7 July2021 on the databases (bases de données) Psychinfo APA, Scopus, PubMed, as well as the bases de données of the Cochrane organisation and the recommendation documents of the Haute Autorité de la santé. After an initial selection based on keywords, the full text of all articles were read to arrive at the final selection of 32 articles. ResultsAntidepressants and Cognitive Behavioural Therapies (CBT) appear to be the most commonly recommended treatments for PMDD. Other research shows the effectiveness of oral contraceptives including drospirenone. Selective serotonin reuptake inhibitors (SSRIs) were identified as an effective treatment for PMDD. These data are consistent with the current etiological hypothesis of PMDD which has a negative impact of natural hormonal fluctuations on certain neurotransmitters. CBT showed positive results in reducing the functional impact of PMDD. DiscussionSelective serotonin reuptake inhibitor (SSRI) antidepressants were reported to be first-line treatments for PMDD (sertraline 50–150 mg/d, fluoxetine 10–20 mg/d, escitalopram 10–20 mg/d, paroxetine 12.5–25 mg/d). Drospirenone (EE 3 mg and EE 20 mg/d 24 days of hormonal pills, 4 days inactive) appears to have been a first or second line treatment depending on the articles. Current results clearly point to the effectiveness of CBT in helping to reduce: functional impairment, depressed mood, feelings of hopelessness, anxiety, mood swings, sensitivity, irritability, insomnia, conflict with others, impact of premenstrual symptoms on daily life, intensity of symptoms experienced, and symptom handicap. CBTs could also become a first-line treatment if there were to be more evidence of their effectiveness. In the future, it would seem useful to offer a psychotherapeutic treatment that can be reproduced and to multiply research with a high level of scientific comparability in order to clarify the place of CBT in the management of PMDD. Research on the etiopathology of the disorder and the optimal drug regimen is still ongoing. There is a need to develop appropriate psychotherapeutic techniques to support and accompany these patients. ConclusionIn order to better evaluate treatments for PMDD, there is a need to homogenise studies on the subject at several levels: design, treatment doses, psychotherapeutic techniques, and evaluation measures. At present, some studies include both premenstrual syndrome (PMS) and PMDD patients. PMS and PMDD do not include the same symptoms, nor the same severity and potentially the same aetiology in the patients studied. In order to propose rigorous research that evaluates the effectiveness of treatments for PMDD and to properly support people with both these disorders, it seems essential to distinguish the two conditions. The role of the health practitioner is to be able to identify PMDD by differentiating it from other clinically related disorders. The patient must then be accompanied to make a choice of treatment adapted to her symptoms, their severity, her history, her plans for procreation, contraindications and her preferences. In 2021, the French National Authority for Health did not offer any guidelines or recommendations for the management of premenstrual dysphoric disorder. There is a need to develop research in France.

Characterization of pathogenic factors for premenstrual dysphoric disorder using machine learning algorithms in rats

We established a methodology using machine learning algorithms for determining the pathogenic factors for premenstrual dysphoric disorder (PMDD). PMDD is a disease characterized by emotional and physical symptoms that occurs before menstruation in women of childbearing age. Owing to the diverse manifestations and various pathogenic factors associated with this disease, the diagnosis of PMDD is time-consuming and challenging. In the present study, we aimed to establish a methodology for diagnosing PMDD. Using an unsupervised machine-learning algorithm, we divided pseudopregnant rats into three clusters (C1 to C3), depending on the level of anxiety- and depression-like behaviors. From the results of RNA-seq and subsequent qPCR of the hippocampus in each cluster, we identified 17 key genes for building a PMDD diagnostic model using our original two-step feature selection with supervised machine learning. By inputting the expression levels of these 17 genes into the machine learning classifier, the PMDD symptoms of another group of rats were successfully classified as C1–C3 with an accuracy of 96%, corresponding to the classification by behavior. The present methodology would be applicable for the clinical diagnosis of PMDD using blood samples instead of samples from the hippocampus in the future.

Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study.

The study aimed to determine potential risk factors associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Three hundred two female student participants who were 18-45 years old completed a questionnaire including demographic characteristics, lifestyle factors, and a Vietnamese Premenstrual Syndrome Screening Tool. We then followed up participants during at least two menstrual cycles using the Daily Record of Severity of Problems. The Premenstrual Syndrome and Premenstrual Dysphoric Disorder diagnosis was established using The Carolina Premenstrual Assessment Scoring System, based on the American College of Obstetrics and Gynecology and Diagnostic and Statistical Manual of Mental Disorders. According to the Carolina Premenstrual Assessment Scoring System, 35 out of 302 students (11.6%; 95%CI: 8.2-15.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). We found that age at menarche (PR = 0.77, 95%CI: 0.63-0.96), having negative Rh blood type (PR = 4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR = 2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having Premenstrual Syndrome or Premenstrual Dysphoric Disorder after adjusting for other variables. The prominent risk factors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression.

Risks of major affective disorders following a diagnosis of premenstrual dysphoric disorder: A nationwide longitudinal study.

Whether a history of premenstrual dysphoric disorder (PMDD) is associated with a subsequent risk of major affective disorders remains unclear. This study aimed to examine the risk of unipolar depression and bipolar disorder in women with PMDD compared with those without PMDD. This study used data from the Taiwan National Health Insurance Research Database. Women who were diagnosed with PMDD and had no history of any major affective disorder were included. The controls were women without PMDD matched for demographics and physical and psychiatric comorbidities. Cox regression was used to estimate the risk of unipolar depression and bipolar disorder. We included 8222 women with PMDD and 32,888 matched controls. After adjusting for potential confounders, we found that the women with PMDD were associated with a higher risk of unipolar depression [hazard ratio (HR) 2.58; 95% confidence interval (CI), 2.23-2.98] and bipolar disorder (HR 2.50; 95% CI 1.62-3.88) than the controls. The PMDD group had a younger age at the diagnosis of unipolar depression (37.11 vs 41.59 years) and bipolar disorder (35.59 vs 42.02 years, p=0.002), and shorter duration between enrollment and onset of unipolar depression (2.97 vs 5.33 years, p<0.001) and bipolar disorder (3.05 vs 5.57 years, p<0.001). Our results showed a strong association between PMDD and major affective disorders. Healthcare workers should be aware of patients with PMDD and the risk of developing major affective mental disorders.

Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study.

Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.

Mediating effect of negative perceived stress on the relationship between premenstrual syndrome and emotional eating.

Emotional eating is one of the eating behaviors in which negative emotions affect eating. During the luteal phase, premenstrual syndrome (PMS) and its associated psychological and physical symptoms can appear in some women, and a few of them suffer from premenstrual dysphoric disorder (PMDD), a severe form of PMS. Some women diagnosed with PMS/PMDD experience emotional eating during the luteal phase, which may be a coping mechanism for psychological stress. This study aimed to investigate how PMS/PMDD and negatively perceived stress are related to emotional eating. A total of 409 women aged 20 to 39 yrs with a body mass index (BMI) ranging from 18.5 to 29.9 kg/m2 participated in this study. Participants who responded to all the questions of the Shortened Premenstrual Assessment Form, Negative Perceived Stress Scale, and Emotional Eater Questionnaire were divided into a PMDD and a non-PMDD group according to the cut-off value for PMDD diagnosis. Independent t-tests and mediation analyses were performed to compare the 2 groups. No significant differences between the 2 groups were found in terms of BMI; however, the average values for emotional eating, PMS, and negative perceived stress of the PMDD group were significantly higher than those of the non-PMDD group. Only negative perceived stress had a significant effect on emotional eating in the non-PMDD group. In the PMDD group, PMS was statistically significant for both negative perceived stress and emotional eating mediated by negative perceived stress. Consequently, it appeared to have a partial or complete mediation depending on the independent variable for the PMDD group. This study highlights the importance of managing negative perceived stress to control emotional eating in PMS/PMDD for improved women's health.

Characteristics of Premenstrual Dysphoric Disorder in Moroccan Women: A Cross-Sectional Study

Premenstrual dysphoric disorder (PMDD) is not sufficiently studied in Arab populations. The aim of this study was to describe the epidemiological, emotional and physical characteristics of premenstrual dysphoric disorder in the Moroccan women using the Daily Record of Severity of Problems (DRSP) according to the DSM criteria. The DRSP was translated in French and dialectal Arabic and published, from November 2021 to January 2022, on different Facebook female groups. Of the 675 women who responded to our questionnaire, 451 women were retained (exclusion criteria) and of these 451 women, 372 met the DSM-5 TR criteria for the diagnosis of premenstrual dysphoric disorder (55%). 97% had an academic educational level, 61% were single, and only 15% used contraception. The clinical symptomatology was dominated by depressive symptoms, concentration difficulties; decreased interest in usual activities and moodiness. Physical symptoms were present in more than 60% of women, and the most commonly reported symptom was muscle and/or joint pain (82%).

Unmet Needs Discussed on Reddit by Women with Premenstrual Dysphoric Disorder.

Premenstrual dysphoric disorder (PMDD) is a disabling disorder that impacts 1.8 percent to 5.8 percent of menstruating women for 1-2 weeks each month. Many affected women turn to social media platforms for the information and the support they feel that they do not get from other sources. We sought to better understand the most strongly expressed unmet needs of women with PMDD by analyzing their posts and comments on one of the largest social media platforms (Reddit), which has been providing important insights into other medical problems. We searched Reddit using the subreddit title "r/PMDD" for posts from January 2020 through November 2021. To identify the most prevalent issues, we included all written posts with a submission score of at least 5 and at least three comments. Two authors classified each post; inconsistencies were resolved by a third reviewer. Over 800 posts were reviewed; 250 met study criteria; additionally, over 875 comments were evaluated. Four main themes emerged from the analysis: emotional responses to PMDD; unanswered questions women had about the diagnosis and treatment of PMDD; the impact that PMDD had on personal relationships, and, finally, the recommendations women made to others based on their own experience, accurate or not. These themes are detailed in this article to provide insights into what many women with PMDD experience and what their frustrations and misunderstandings are about the condition so that clinicians may better help address women's unspoken questions and correct their possible misinformation.

The pharmacotherapeutic management of premenstrual dysphoric disorder

ABSTRACT Introduction Premenstrual dysphoric disorder (PMDD) is a prevalent psychiatric condition associated with substantial mental distress, impaired psychosocial functioning, high rates of co-morbid psychiatric conditions, and elevated risk of suicide. Areas covered We provide an update on epidemiology, pathophysiology, clinical presentation, and diagnosis of PMDD, with a focus on the pharmacological management of this condition. Expert opinion Given the high rates of false positives from retrospective assessments, prospective daily symptom monitoring for a minimal of two symptomatic menstrual cycles is critical to accurately confirm (or rule out) the diagnosis of PMDD. Serotonin-based antidepressants are well-established first-line treatments of PMDD. Second-line treatment includes the use of combined, monophasic oral contraceptives. In mild to moderate cases, independent meta-analyses have shown efficacy of Chasteberry extract (Vitex agnus cactus). Preliminary results with compounds blocking the synthesis of allopregnanolone are promising.

Premenstrual syndrome and premenstrual dysphoric disorder

Premenstrual syndrome (PMS) is one of the most common problems for women of reproductive age. The physical, mental and behavioural symptoms recur during the luteal phase of the cycle in daily life and cause a deterioration in the quality of life, affecting the patient's social, work and family relationships. Symptoms typically disappear spontaneously within a few days after the onset of menstruation. The onset and severity of PMS are determined by the cyclical functioning of the hypothalamic-pituitary-ovarian axis and the combined presence of other physiological (e.g., chronobiological and circadian) and psychological stressors, which interact with each other. The diagnosis of PMS and premenstrual dysphoric disorder (PMDD) is based on the following criteria, as recommended by the International Society for Premenstrual Disorders (ISPMD): in PMS, the woman has 1-4 symptoms, which may be physical, behavioural or affective/psychological, or at least five symptoms, which may be physical or behavioural. However, if a woman has 5 or more symptoms, and one of these is affective (e.g., irritability, mood swings, anger) in addition to physical or behavioural symptoms, a more accurate diagnosis of PMDD can be made. Since, in addition to the general and gynecological history, the prospective scales (e.g., Prospective record of the impact and severity of menstrual symptoms - PRISM; Daily record of severity of problems - DRSP) completed daily by the physician are helpful in confirming the diagnosis of PMS and PMDD, it is important to take into account the severity of symptoms, the woman's plans for conception or contraceptive needs, her other associated medical conditions, her response to previous treatment methods, and her history of other medical conditions when formulating a treatment plan. Therapeutic options include regular aerobic exercise, stress relief, cognitive behavioural therapy, drug treatments (selective serotonin reuptake inhibitors - SSRIs, combined oral estrogen-progestin contraceptives - COCs, GnRH agonists), -depending on the severity of PMS and PMDD.

Pardon My Sobbing: A Qualitative Study on Differentiating Generalised Mood Disorders From Premenstrual Dysphoric Disorder

AimsTo assess current diagnostic methods used in the United Kingdom which have led to successful diagnoses of PMDD (Premenstrual Dysphoric Disorder).MethodsWomen suffering from PMDD were recruited across the United Kingdom. Participants were interviewed using a semi-structured interview guide about their paths to diagnoses and the impact of receiving a misdiagnosis. Interviews were transcribed and thematically analysed to assess for overarching themes and similarities across participants. The Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 survey, and Premenstrual Symptom Screening Tool were used to assess for each questionnaire's diagnostic ability.ResultsFour women aged 30–50 years all identifying as PMDD patients were interviewed. All four participants received misdiagnoses of major depressive disorder and/or generalised anxiety disorder. The key to achieving a PMDD diagnosis for all four women was awareness of the cyclical nature of their symptoms. All three surveys failed to fulfill all the diagnostic criteria for PMDD, however the Premenstrual Symptom Screening Tool performed the best and elicited the greatest number of symptoms from the population sample.ConclusionThis research showed the need for patient awareness of PMDD via research, or awareness of the relationship between symptoms and the menstrual cycle, to achieving a diagnosis and receiving adequate treatment. Specialist treatment was also imperative to achieving a formal diagnosis.

Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder

BackgroundSuicide is the second leading cause of death among Americans ages 10 to 34, with alarming recent increases in suicide rates among those assigned female at birth. A large body of evidence points to menstrual cycle influences on self-injurious thoughts and behaviors (STBs), suggesting that neurobiological hormone sensitivities, such as in premenstrual dysphoric disorder (PMDD), may drive suicide risk in females. However, existing studies of STBs in PMDD use cross-sectional self-report measures of PMDD with poor validity. As a first step to establish accurate prevalence rates of STBs in PMDD, we examined the lifetime prevalence of STBs in a large global survey of patients reporting a diagnosis of PMDD based on daily ratings.MethodIndividuals with self-reported PMDD symptoms were invited to an online survey through online support groups for PMDD and social media posts from PMDD awareness accounts. Participants reported demographics, whether they had been diagnosed with PMDD by a healthcare provider using daily ratings, STBs using the Columbia Suicide Severity Rating Scale, and history of lifetime comorbid psychiatric diagnoses.ResultsOf 2,689 survey completers, 599 (23%) reported a diagnosis with PMDD based on two months of daily ratings and were included in analyses. We observed high rates of lifetime active suicidal ideation (72%), planning (49%), intent (42%), preparing for an attempt (40%), and attempt (34%), as well as non-suicidal self-injury (51%). The majority (70%) of the sample reported at least one lifetime comorbid psychiatric diagnosis. Predictors of lifetime active suicidal ideation included nulliparity, low-to-moderate (vs. high) income, and history of diagnosis with major depression or post-traumatic stress disorder. Predictors of lifetime attempts among those reporting lifetime active ideation included older age, nulliparity, lower income, and history of diagnosis with post-traumatic stress disorder or borderline personality disorder.ConclusionsThese data indicate high rates of STBs among those reporting prospective diagnosis of PMDD and highlight the need for prospective research on mechanisms and prevention of STBs in PMDD. Clinical practice guidelines for PMDD should accommodate comorbidities and recommend frequent screenings for STB risk. STBs should be considered for inclusion in future iterations of the DSM PMDD diagnostic criteria.

Prevalence and correlates of current suicidal ideation in women with premenstrual dysphoric disorder

BackgroundAlthough previous studies report an association between Premenstrual Dysphoric Disorder (PMDD) and suicidal ideation, most studies have only established a provisional and retrospective diagnosis of PMDD fundamentally invalidating the diagnosis. Therefore, the aim of this study was to describe the prevalence and to explore correlates of current suicidal ideation in the late luteal phase in women with prospectively assessed and confirmed PMDD.MethodsParticipants were 110 women who attended the pre-randomization baseline visit of two randomized placebo-controlled clinical trials between January 15, 2017 and October 19, 2019. PMDD was diagnosed prospectively in line with DSM-5 criteria. Current suicidal ideation was measured by the MADRS-S in the late luteal phase. Descriptive statistics were presented and logistic regression analyses were carried out to explore the association between psychosocial and health characteristics and current suicidal ideation, presenting unadjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsCurrent suicidal ideation was reported by nearly 40% of women with confirmed PMDD (n = 43, 39.1%). Previous psychological treatment for PMDD and higher depressive symptoms in the late luteal phase were positively associated with current suicidal ideation (OR 5.63, 95% CI 1.07–29.49, and OR 1.17, 95% CI 1.10–1.25, respectively), whereas higher ratings of self-rated health were associated with lower odds ratios for current suicidal ideation (OR 0.98, 95% CI 0.96–0.99).ConclusionsA substantial proportion of women with confirmed PMDD report current suicidal ideation in the late luteal phase. Results point to a need for better awareness and screening of suicidal ideation in women with PMDD.

Pilot Data on the Feasibility And Clinical Outcomes of a Nomegestrol Acetate Oral Contraceptive Pill in Women With Premenstrual Dysphoric Disorder.

BackgroundUp to 80% of reproductive-aged women experience premenstrual symptoms. Premenstrual Dysphoric Disorder (PMDD) is a severe form, affecting 2-5% of women. Combined oral contraceptive pills (COCPs) are used in the treatment of PMDD. Clinical practice suggests that a newer COCP containing nomegestrol acetate (2.5mg) and 17-beta estradiol (1.5mg), may be a suitable treatment for mood symptoms in PMDD.Materials and MethodsThis was a clinical follow-up feasibility study of women who had attended the Monash Alfred Psychiatry research centre, Women’s Mental Health Clinic, with a diagnosis of PMDD. 67% of the sample also had concurrent cPTSD, 29% co-morbid anxiety, and 20% depression. They were recommended treatment with nomegestrol acetate/17-beta estradiol. Eligible women were contacted by telephone to answer a questionnaire to assess women’s subjective response to nomegestrol acetate/17-beta estradiol, acceptability and the Depression, Anxiety and Stress Scale-21 (DASS-21) after being recommended nomegestrol acetate/17-beta estradiol. The paired-sample t-test was used to determine if there were any statistically significant differences in the DASS-21 scores over the study observation period (before and after taking nomegestrol acetate/17-beta estradiol).Results35 (74.5%) women reported a subjective positive mood response to nomegestrol acetate/17-beta estradiol, 31 (63.3%) adhered to the medication, and only 10 (20.4%) women reported side effects as the main reason for discontinuing nomegestrol acetate/17-beta estradiol. There were statistically significant reductions (p<0.05) in the overall DASS-21 scores from before women commenced nomegestrol acetate/17-beta estradiol and after commencement of treatment.ConclusionsThis preliminary study supports the acceptability and effectiveness of nomegestrol acetate/17-beta estradiol as a treatment for mood symptoms in PMDD. Further research, particularly a randomized controlled trial, is required to elucidate the effect of nomegestrol acetate/17-beta estradiol treatment on mood in PMDD.

A randomized, double-blind study on efficacy and safety of sepranolone in premenstrual dysphoric disorder

Women with premenstrual dysphoric disorder (PMDD) experience mood symptoms related to the increase in progesterone and the neuroactive steroid allopregnanolone. Our hypothesis is that allopregnanolone is the symptom provoking factor. The rationale for the present study was to treat PMDD patients with the GABAA receptor modulating steroid antagonist, sepranolone (isoallopregnanolone). Patients (n = 206) with PMDD from 12 European centers were randomized in a parallel double-blind study and treated with placebo, sepranolone 10 mg and 16 mg. Patients administered sepranolone subcutaneously every 48 h during the 14 premenstrual days of three consecutive menstrual cycles. After obtaining informed consent, the PMDD diagnosis was confirmed according to DSM-5 and verified with two menstrual cycles of daily symptom ratings using the Daily Record of Severity of Problems (DRSP) scale in an eDiary. Inclusion and exclusion criteria stipulated that the women should be essentially healthy, not pregnant, have no ongoing psychiatric disorder or take interfering medications, and have regular menstrual cycles. The study’s primary endpoint was the Total symptom score (Sum21, the score for all 21 symptom questions in the DRSP). In the prespecified statistical analysis the average score of the 5 worst premenstrual days in treatment cycles 2 and 3 were subtracted from the corresponding average score in the two diagnostic cycles. The treatment effects were tested using analysis of variance in a hierarchal order starting with the combined active sepranolone treatments vs. placebo. The prespecified analysis of Sum21 showed a large treatment effect of all three treatments but no statistically significant difference to placebo. However, the ratings of distress showed a significant treatment effect of sepranolone compared to placebo (p = 0.037) and the ratings of impairment showed a trend to greater treatment effect of sepranolone compared to placebo. Many women with PMDD had symptoms during a longer period than the late luteal phase. It has previously been shown that 9 premenstrual days may be more representative for comparison of PMDD symptom periods than the 5 worst premenstrual days. A post hoc analysis was undertaken in the per protocol population investigating the treatment effect during 9 premenstrual days in the third treatment cycle. The Sum21 results of this analysis showed that the sepranolone 10 mg was significantly better than placebo (p = 0.008). Similar significant treatment effects were found for the impairment and distress scores. A significantly larger number of individuals experienced no or minimal symptoms (Sum21 <42 points) with the 10 mg sepranolone treatment compared to placebo (p = 0.020). The results indicate that there is an attenuating effect by sepranolone on symptoms, impairment, and distress in women with PMDD especially by the 10 mg dosage. Sepranolone was well tolerated, and no safety concerns were identified.

Copy number variation profile-based genomic typing of premenstrual dysphoric disorder in Chinese

Premenstrual dysphoric disorder (PMDD) affects nearly 5% of women of reproductive age. Symptomatic heterogeneity, together with largely unknown genetics, has greatly hindered its effective treatment. In the present study, analysis of genomic sequencing-based copy number variations (CNVs) called from 100 kb white blood cell DNA sequence windows by means of semisupervized clustering led to the segregation of patient genomes into the D and V groups, which correlated with the depression and invasion clinical types, respectively, with 89.0% consistency. Application of diagnostic CNV features selected using the correlation-based machine learning method enabled the classification of the CNVs obtained into the D group, V group, total patient group, and control group with an average accuracy of 83.0%. The power of the diagnostic CNV features was 0.98 on average, suggesting that these CNV features could be used for the molecular diagnosis of the major clinical types of PMDD. This demonstrated concordance between the CNV profiles and clinical types of PMDD supported the validity of symptom-based diagnosis of PMDD for differentiating between its two major clinical types, as well as the predominantly genetic nature of PMDD with a host of overlaps between multiple susceptibility genes/pathways and the diagnostic CNV features as indicators of involvement in PMDD etiology.