Getting to the Diagnosis: A Case Study on a 51-Year-Old Female with Anxiety, Depression, and Suicidal Ideations

This case study explores the diagnosis and treatment of a 51-year-old female with exacerbated anxiety and depressive symptoms, which worsened prior to menstruation. Initial concerns involved the maximum dosage of psychiatric medications with persistent major depressive disorder and suicidal ideations. This led to a referral for a comprehensive evaluation to assess potential underlying medical conditions. The evaluation revealed multiple contributing factors, including hormonal imbalances, hypothyroidism, and vitamin deficiencies. This case highlights the importance of a thorough diagnostic approach to identify and address underlying conditions that may exacerbate mental health issues.

The Prevalence and Symptoms of Premenstrual Syndrome under Examination

Introduction: Premenstrual Syndrome (PMS) is a common disorder in childbearing age. Based on different definitions, it is accompanied with specific annoying symptoms that clearly emerge after ovulation and decrease or end with the onset of menstruation. Methods: The present study aimed to determine the prevalence of premenstrual syndrome in university students of Sistan and Baluchestan University (Iran) in the academic year 2013-2014. Two hundred and one female university students living in dormitories were randomly selected. The subjects completed two questionnaires of Demographic Information and Symptom Assessment based on the criteria of ACOG and DSM-IV. Results: According to the mentioned criteria, “36.3%” of subjects suffered from Premenstrual Dysphoric Disorder (PMDD) and “85.6%” of subjects indicated the symptoms of PMS. The severity of PMS in 14(%7) subjects was high. Of 86 and 72 subjects “42.8%” and “35.8%” was moderate respectively, it was mild. Among university students, the most common mood symptom (emotional) and somatic symptom (physical) were fatigue and lethargy and abdominal pain (“72.6%” and “62.7%”, respectively). PMS was significantly related to dysmenorrhea and severity of menstrual pain (p < 0.05). Conclusion: Given the high prevalence of this syndrome and its effect on various aspects of life, we highly recommend informing young individuals through books, workshops and media in order to identify the symptoms, provide information about methods of control and treatment of this syndrome, and apply non-interventional treatments and methods to reduce the symptoms.

Are premenstrual symptoms associated with health anxiety in nursing graduates?

Objective: This study examined retrospectively the relationship between premenstrual symptoms and health anxiety. Methods: Premenstrual symptoms of nursing school graduates were assessed in 1985 and again in 1991 using the Premenstrual Assessment Form (PAF). A total of 571 women completed the survey in 1991, along with items relating to their physical and mental health. The latter included depression, anxiety, and panic attacks. Health anxiety was also assessed using the Whiteley Index (WI). After women who were amenorrheic for any reason were excluded, a final sample of 410 women aged 25 to 52 years was obtained. Factor analyses yielded 57 items that were useful for calculating a total PAF score. A stepwise multivariate linear regression model was used to find the association of PAF scores with various participant characteristics. Results: Thirty-kone of the 410 (7.6%) women had WI scores of ≥5 and were considered to have significant health-related anxiety. The PAF score had statistically significant associations with health anxiety, as well as depression and anxiety. Conclusions: Our results suggest that the premenstrual symptoms often coexist with health anxiety as well as other psychological symptoms. Clinicians should be alert to the fact that PMS may be associated with treatable psychiatric conditions.

Plasma protein oxidation and total antioxidant power in premenstrual syndrome

Objective:To explore whether oxidative stress has any role in premenstrual syndrome(PMS). Methods:Female volunteers suffering from PMS,in the age group of 20-24 years were compared to their asymptomatic normomennorhoeic counterparts in follicular phase and late luteal phase for ferric reducing antioxidant power of plasma(FRAP),plasma protein thiols(PPT) and protein carbonyls(PPC) levels.Results:There was no significant change in FRAP and PPC levels in controls and PMS groups but PPT decreased significantly in luteal phase of PMS(P【 0.05) when compared to follicular phase.Conclusions:Estrogen and progesterone,might be responsible for a healthy antioxidant profile in PMS.However,a marked decrease in PPT in luteal phase of PMS group may be due to pro-oxidant nature of estrogen-active in this phase of PMS leading to consumption of the sacrificial antioxidant-protein thiol.

An exploratory pilot of factors associated with premenstrual syndrome in minority women

Purpose:This investigation explored factors associated with premenstrual syndrome(PMS)in minority women,and compared the response of minority and non-minority women supplemented with omega-3 fatty acids(FA)in the form of fish oil.Methods:This descriptive,correlational,retrospective pilot was a secondary data analysis.Participants consuming 2 g of fish oil/d(n=15)in the larger study were included.The Moos Menstrual Distress Questionnaire(MMDQ)was assessed monthly for two months to acquire a mean baseline MMDQ score.The total sample was stratified to evaluate racial variations in PMS symptoms(non-minority,n=7;minority,n=8).MMDQ score at 5 months was compared to the mean baseline score within each group.Results:Fish oil supplementation significantly reduced PMS symptoms in both groups(nonminority p=0.002;minority p=0.046)with a large effect of 1.4 for both groups.Mean MMDQ total scores were not significantly different between groups at 5 months.Conclusions:This pilot evidence of improved PMS symptoms in minority and non-minority groups related to fish oil supplementation supports a universal treatment approach and highlights need for a larger-scale investigation.

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.

Questions relating to premenstrual asthma

The study of asthma in fertile women needs to consider its potentially recurrent exacerbation in a specific phase of the menstrual cycle. Premenstrual asthma(PMA)refers to the deterioration of asthma in some women of fertile age during the premenstrual phase. Prevalence varies considerably according to studies(11%-47.44%) mainly because there is no standardized definition of the illness. There is a possible link between PMA and premenstrual syndrome, which is a set of physical and psychic manifestations that occur in some fertile women during the same premenstrual phase. This relation has been widely studied but there are still several unknowns. PMA etiopathogeny is not known. It involves possible causes such as hormonal variations in the premenstrual phase, the coexistence of atopy, variations during the cycle in substances related to inflammation, like LTC4 leukotrienes, catecholamines, E2 and F2α prostaglandins and certain cytokines. Also considered are psychological factors related to this phase of the menstrual cycle, a high susceptibility to infection or increased bronchial hyperreactivity prior to menstruation. Yet no factor fully explains its etiology, consequently no specific treatment exists. Researchers have investigated hormones, antileukotrienes, prostaglandin synthesis inhibitors, diuretics, phytoestrogens and alternative therapies, but none has been shown to be effective.

Metabolic and Behavioral Patterns in a Pre-Menstrual Syndrome Animal Model with Liver-qi Invasion and Their Reversal by a Chinese Traditional Formula

This work successfully used model rats with Pre-Menstrual Syndrome (PMS) liver-qi invasion in the early de-velopment days to detect the Metabolic and Behavioral Patterns and their reversal by a Chinese traditional for-mula. Our aim is to verify the reliability of PMS liver-qi invasion rat model and explore some micro- mecha-nism of the syndrome of the liver failing to maintain the normal flow of qi. 30 rats with estrous cycles not in accepting time were selected and divided randomly into three groups: the normal control group, PMS liver-qi invasion model group and PMS liver-qi invasion medication-administered group. Emotional stimulation and multiple factors combination were used to prepare the PMS liver-qi invasion model. Baixiangdan Capsules (a Chinese traditional formula) were administered to rats to interfere with the PMS liver-qi invasion mode. Open-field test was used to explore behavioral aspects of the model. Urine samples, from the three groups, were collected and analyzed with UPLC-Q-TOF method to detect changes in metabolites related to liver func-tions. In the open-field experiment, the crossing scores, rearing scores and open-field experiment total scores of rats in the PMS liver-qi invasion model group increased remarkably (P < 0.05) compared with the scores of the normal control group, the tendency was retrieved remarkably after medications (P < 0.05). Metabolic finger-prints between the PMS liver-qi invasion model group and the normal control group had also distinguished changes through principal component analysis, and an evident restoration trend occurred after Baixiangdan Capsules administration. Taken together, behavioral and metabolic patterns can differentiate the PMS liver-qi invasion rat models from the normal rats. Our results identified potential biological markers that might reflect metabolic pathologies associated with PMS liver-qi invasion.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE THERAPY FOR SIMPLE OBESITY COMPLICATED WITH PREMENSTRUAL TENSION SYNDROME

Objective: To observe the therapeutic effect of acupuncture therapy in the treatment of simple obesity complicated with premenstrual tension syndrome. Methods: A total of 39 cases of simple obesity complicated with premenstrual tension were treated by combination of body acupuncture and otoacupuncture based on syndrome-differentiation of traditional Chinese medicine (TCM). Symptoms, physical signs, obesity indexes and cumulative scores of clinical disease-syndrome before and after treatment were analyzed and compared. Results: After one, two and three courses of treatment, the effective rates were 69.23%, 79.49% and 87.18% respectively. Conclusion: Acupuncture therapy works well in the treatment of simple obesity with concurrent premenstrual tension syndrome.

ACUPUNCTURE TREATMENT OF FEMALE OBESITY COMPLICATED WITH PREMENSTRUAL TENSION SYNDROME

Objective： To explore mechanisms of acupuncture for the treatment of obesity complicated with prernenstrual tension syndrome （PTS）. Methods： By means of syndrome-differentiation, 45 female simple obese （SO） patients with PTS （SO＋ PTS group and 35 simple obesity patients （SO group） were treated with body acupuncture combined with ear acupuncture. Thirtythree normal women subjects were assigned to control group. Changes in symptoms, signs, obesity index, clinical indices of disease and syndrome, equilibrium index of the vegetative nervous system （Y value）, blood estradiol （E2）, progesterone （P）, aldosterone （Aid） and lipid levels were detected and compared before and after the treatment. Results： Before acupuncture treatmerit, the obesity index, clinical indices of disease and syndrome, Y value, E2/P ratio and Aid in these patients were obviously increased, and E2 and P levels decreased. After the treatment, the body weight of the patients was reduced, and the increased obesity index, clinical indices of diseases and syndromes, Y value, E2/P ratio and Aid were markedly lowered （P〈0.05, or P 〈 0.01）, and the decreased E2 and P levels elevated significantly （P〈 0.01）. Conclusion： Acupuncture exerts favorable regulative function on clinical indices of disease and syndrome, Y value, E2, P, Aid, lipid and E2/P in obese patients with PTS, which may be related to its resultant improvement of the functions of the hypothalamo-pituitary-gonedal axis, hypothalamo-pituitary-adrenal axis and the vegetative nervous system.

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.

Effectiveness and safety of Jiawei Xiaoyao pill(加味逍遥丸)in the treatment of premenstrual syndrome(liver depression,spleen deficiency,and blood-heat syndrome):a multi-center,randomized,placebo-controlled trial

OBJECTIVE:To investigate the effectiveness and safety of Jiawei Xiaoyao pill(加味逍遥丸,JXP)in the treatment of symptoms associated with premenstrual syndrome(PMS).METHODS:A total of 144 regularly menstruating women with PMS were recruited at 8 sites in China from August 2017 to December 2018,and randomized to receive either a JXP or a matching placebo(12 g/d,6 g twice a day)for 3 menstrual cycles.The primary indicator was the reduced Daily Record of Severity of Problems(DRSP)scores in the luteal phase after 3 months of treatment.The safety outcomes included clinical adverse events(AEs),adverse reactions(ARs),changes in vital signs,and laboratory tests.RESULTS:JXP surpassed the placebo in reducing DRSP scores(psychological/somatic dysfunction)in the luteal phase over 3 menstrual cycles of treatment(PFAS=0.002,PPPS=0.001).Additionally,there were no significant differences in the incidence of AEs,severe AEs,withdrawal due to AEs and ARs between the two groups(all P>0.05),and no clinically significant adverse medical events related to the test drug observed.CONCLUSIONS:JXP was superior to the placebo in relieving the symptoms associated with PMS,which signified that JXP may be effective,safe,and welltolerated as an alternative therapy.

Efficacy and Safety of Ganyushu Granule in Treatment of Premenstrual Syndrome with Gan(Liver)Depression and Qi Stagnation Syndrome:A Randomized,Double-Blind,Multicenter,Phase-ⅡClinical Trial

Objective:To confirm the efficacy and safety of Ganyushu Granule(GYSG)in treating premenstrual syndrome(PMS)in patients with Gan(Liver)depression and qi stagnation syndrome(GDQSS)and determine its effective dosage.Methods:From June 2018 to March 2021,a total of 240 PMS women with GDQSS were included and randomly divided into 3 groups in a 1:1:1 ratio using central block randomization:high-dose GYSG group(n=78,GYSG 2 packs/time),low-dose GYSG group(n=82,GYSG and its simulant 1 pack/time),and placebo group(n=80,GYSG simulant 2 packs/time).Treatment with GYSG or placebo was given thrice daily and for up to 3 menstrual cycles.Primary outcomes were PMS diary(PMSD)score and premenstrual tension syndrome self-rating scale(PMTS).Secondary outcomes were Chinese medicine(CM)syndrome efficacy.PMSD,PMTS,and efficacy of CM were evaluated with menstrual cycles during the treatment period.Outcome indicators were analyzed after each menstrual cycle.All analyses were performed using an intention-to-treat method,and clinical safety was assessed.Results:Of the 216 patients included in the effectiveness analysis,70,75,and 71 patients were in the high-,low-dose GYSG,and placebo groups,respectively.From the 2nd treatment cycle,the change in PMSD scores in the high-and low-dose groups was lower than that in the placebo group(P<0.05).PMTS scores in the high-dose GYSG group after the 1st treatment cycle was lower than that in the placebo group(P<0.05),while after the 3rd treatment cycle,that in the low-dose group was lower than that in the placebo group(P<0.05).After the 2nd treatment cycle,the high-dose GYSG group had the best CM syndrome efficacy(P<0.05).No serious adverse reactions were reported.Conclusions:GYSG was safe and well-tolerated at both doses for treating PMS patients with GDQSS.High-dose GYSG might be the optimal dose for a phaseⅢtrial.

Efficacy of Curcumin on Cognitive Function Scores in Women with Premenstrual Syndrome and Dysmenorrhea: A Triple-Blind, Placebo-Controlled Clinical Trial

Objective: To assess the efficacy of a curcumin supplementation on cognitive abilities in women suffering from premenstrual syndrome(PMS) and dysmenorrhea. Methods: A randomized, triple-blind, placebocontrolled trial was conducted from December 2019 to March 2020. A total of 124 women who had both PMS and dysmenorrhea were enrolled, and were equally and randomly assigned to the curcumin group or placebo group, 62 cases in each. Each subject received either a capsule containing 500 mg of curcuminoid, or a placebo daily, for 10 days(7 days before and until 3 days after the onset of menstrual bleeding) over 3 menstrual cycles. The cognitive abilities questionnaire was used to measures cognitive functions in 7 specific areas. Adverse reactions were monitored during and after the trial in both groups. Results: Administration of curcumin was associated with a significant increase in memory score(P=0.002), inhibitory control and selective attention(P=0.020), and total cognitive ability task(P=0.024). In addition, significant increments were found in scores of memory(3.5±3.1 vs. 0.4±3.8 in the curcumin and placebo groups, respectively;P=0.035), inhibitory control and selective attention(3.0±3.7 vs. 0.4±3.7;P=0.027) and total cognitive abilities(8.3±12.3 vs. 2.2±12.4;P=0.025) in the curcumin group versus placebo groups. Curcumin was safe and well-tolerable in current clinical trial. Conclusion: Curcumin has a beneficial efficacy on cognitive function scores in women with PMS and dysmenorrhea, with improvements in memory, inhibitory control and selective attention.(Registration No. IRCT20191112045424N1, available at: https://www.irct.ir)

Baduanjin exercise improved premenstrual syndrome symptoms in Macao women

OBJECTIVE: To investigate the effect of Baduanjin,a traditional Chinese medical exercise, on improving premenstrual syndrome(PMS) symptoms in women.METHODS: Forty reproductive age women with PMS in Macao practiced standardized Baduanjin exercise for three menstrual cycles. A questionnaire,the daily record of severity of problems(DRSP), was used to measure symptom severity. DRSP was filled out every days tarting from the last cycle before exercise(i.e., the first menstrual cycle) to the third cycle after exercise initiation(i.e., the fourth menstrual cycle). The total scores and the scores of each item during the 5 premenstrual days and follicular phase(5-9 postmenstrual days)were calculated.RESULTS: After exercise, the total DRSP scores dur-ing the 5 premenstrual days and differences in the total DRSP scores between the 5 premenstrual days and the follicular phase were both significantly reduced. Of note, the physical symptom total scores in the 5 premenstrual days and the differences between its total score in the 5 premenstrual days and in the follicular phase were both significantly reduced. The differences between the total scores of depressed mood, anxious mood, loss of interest,and reduction in social activity during the 5 premenstrual days and the follicular phase were also reduced.CONCLUSION: Baduanjin exercise was able to improve the mental and especially the physical symptoms of PMS.

Factors associated with premenstrual syndrome of emergency nurse: A multicenter study in China

Objective:To study the factors associated with premenstrual syndrome(PMS)in emergency department(ED)nurses.Methods:A multicenter cross-sectional study was conducted in female ED nurses in China.Data gathering questionnaires included the Daily Record of Severity of Problems,Chinese Nurses Stressor Scale,Social Support Rating Scale,and Self-Rating Anxiety Scale.All questionnaires were used to assess the symptoms prospectively over 2 months.Results:A total of 289 ED nurses were recruited.The incidence of PMS was 67.47%.The most common symptoms were tiredness(76.90%),anger(76.90%),restlessness(75.40%),snoring(69.20%).Univariate analysis showed that the BMI and occupational stress score was significantly higher,and the age was significantly younger in the PMS group compared with the non-PMS group.According to the multiple linear regression,the symptoms of PMS were positively associated with the occupational stress score and anxiety score,and negatively with the level of education received.Conclusions:occupational stress,anxiety,and education level may associated with the occurrence of PMS in ED nurses.

Clinical Study on Treatment of Premenstrual Syndrome by Acupuncture and Moxibustion

Premenstrual syndrome（PMS） is a collection of physical and emotional symptoms occurring two weeks prior to woman＇s menstruation, such as tension, emotional upset, attention deficit, irritability, depression and anxiety, insomnia, headache and distending breasts, which vanish shortly after the start of menses. Serious PMS can affect the sufferers＇ work,