Association between Premenstrual Dysphoric Disorder and Systemic Lupus Erythematosus: Exacerbation of Major Depression Symptoms?

Introduction: Systemic Lupus Erythematosus (SLE) usually presents neuropsychiatric manifestations, such as psychosis, convulsion, mood disorder and chronic headache, with mood disorder being the most prevalent. It is also known that other psychiatric disorders and menstrual cycle disorders are frequent in SLE. The aim of this study was to describe for the first time the frequency of premenstrual dysphoric disorder in patients with SLE diagnosis, and its association with depression and anxiety. Material and Methods: An evaluation was made of 62 (sixty-two) patients with diagnosis of SLE, based on the American College of Rheumatology criteria, who received follow-up care at an ambulatory reference center. The patients were submitted to a sociodemographic evaluation questionnaire, upon which the Mini International Neuropsychiatric Interview (MINI PLUS), Brazilian Version 5.0.0, was used to evaluate the diagnosis. Results: Twenty (32%) patients were found to have premenstrual dysphoric disorder, and there was a statistically significant association with major depression (p = 0.010), but no statistical significance was found with dysthymia (p = 0.063) or anxiety (p = 0.223). Conclusions: The frequency of premenstrual dysphoric disorder (PMDD) in patients with SLE was high, as well as the frequency of major depression in this group. There was an association between these two disorders.

Dimensional(premenstrual symptoms screening tool)vs categorical(mini diagnostic interview,module U)for assessment of premenstrual disorders

BACKGROUND Premenstrual syndrome(PMS)is the constellation of physical and psychological symptoms before menstruation.Premenstrual dysphoric disorder(PMDD)is a severe form of PMS with more depressive and anxiety symptoms.The Mini international neuropsychiatric interview,module U(MINI-U),assesses the diagnostic criteria for probable PMDD.The Premenstrual Symptoms screening tool(PSST)measures the severity of these symptoms.AIM To compare the PSST ordinal scores with the corresponding dichotomous MINI-U answers.METHODS Arab women(n=194)residing in Doha,Qatar,received the MINI-U and PSST.Receiver Operating Characteristics(ROC)analyses provided the cut-off scores on the PSST using MINI-U as a gold standard.RESULTS All PSST ratings were higher in participants with positive responses on MINI-U.In addition,ROC analyses showed that all areas under the curves were significant with the cutoff scores on PSST.CONCLUSION This study confirms that the severity measures from PSST can recognize patients with moderate/severe PMS and PMDD who would benefit from immediate treatment.

Is Premenstrual Syndrome a Uterine Inflammatory Disease? Retrospective Evaluation of an Etiologic Approach

Objective: To retrospectively evaluate the efficacy of local uterine antibiotic and anti-inflammatory injections combined with cryotherapy for the treatment of severe Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). To validate the hypothesis of a uterine infectious/inflammatory etiology of PMS/PMDD. Methods: Clinical files of 161 women sequentially treated from September 1995 to April 2005, were collected for study. A subset of 148 patients (mean: 36.7 ± 7.8 years, range: 20.1 - 53.8 years) were eligible for statistical analysis. The ten most relevant PMS symptoms, namely depression, irritability, anxiety, fatigue, headache, edema, breast tenderness, abdominal bloating, pelvic pain and dysmenorrhea, were self-rated before and three menstrual cycles after treatment, using a 0 to 5 scale. The treatment consisted of cervical stromal antibiotic/anti-inflammatory injections combined with intracervical cryotherapy. Scores were compared using non-parametric tests for matched samples. Results: Before treatment, mean severity scores for the 10 symptoms were 3.97 ± 1.17, 4.26 ± 0.88, 3.41 ± 1.23, 3.91 ± 0.94, 3.35 ± 1.71, 2.28 ± 1.69, 2.13 ± 1.63, 4.51 ± 0.63, 2.28 ± 1.30, and 2.28 ± 1.88, respectively. Mean values after treatment were 0.54 ± 0.91, 0.51 ± 0.91, 0.32 ± 0.70, 0.42 ± 0.74, 0.43 ± 0.96, 0.22 ± 0.53, 0.39 ± 0.73, 1.01 ± 0.94, 0.28 ± 0.69, and 0.44 ± 0.92. All tests were statistically significant (p < 0.01). Conclusion: Both PMS physical and psycho-affective symptoms respond to local anti-inflammatory and antibiotic treatment of the uterus, showing a stable improvement after the treatment has ended. The results of this study suggest that the clinical pattern of PMS can be explained as an inflammatory mediated response to uterine infectious or traumatic insults. Further evidence is urgently needed in order to validate this innovative approach for widespread use in severe PMS/ PMDD cases.