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Liang X, Yang T, Liao Y, Yang Z, Lin Y, Wu X, Tao J, Gan Z. The impact of comorbid premenstrual syndrome or premenstrual dysphoric disorder on the clinical characteristics of bipolar disorder among Han Chinese women. Arch Womens Ment Health 2024; 27:67-75. [PMID: 37874397 DOI: 10.1007/s00737-023-01380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Bipolar disorder (BD) is commonly comorbid with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). However, little is known about their relationship. This study aimed to assess the impact of comorbid PMS or PMDD on the clinical characteristics of BD. A cross-sectional study was conducted on 262 women with BD. PMS and PMDD were screened with the Premenstrual Symptoms Screening Tool (PSST). Symptomatic features were assessed with Hamilton Depression Scale (HAMD), Young Mania Rating Scale (YMRS), and atypical features by the depressive episode section of SCID-I/P. The rates of PMS and PMDD among BD were 57.6% and 20.6% according to PSST. No significant difference in the rates of PMS and PMDD was found between BD I, BD II, and BD-NOS. Compared to BD patients without PMS or PMDD, patients with comorbid BD and PMS or PMDD were younger, more educated, had a higher risk of OCD, had an earlier age of onset, scored higher on HAMD-17 and its sub-scale of anxiety/somatization, cognitive deficit, psychomotor retardation, and were more likely to have increased appetite and leaden paralysis. In addition, patients with comorbid BD and PMDD were less likely to experience traumatic life events, more likely to have family history of mental disorders and have inflammatory or autoimmune disease, scored higher on HMAD-17, particularly in its sub-scale of anxiety/somatization, cognitive deficit, psychomotor retardation, and sleep disturbance. Compared with BD without PMS or PMDD, BD with PMS or PMDD might be a specific subtype of BD characterized with earlier onset age, heavier genetic load, increased symptom severity, and atypical features.
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Affiliation(s)
- Xiaolin Liang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Ting Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Yingtao Liao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Zhihua Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Youzhen Lin
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Xiuhua Wu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Jiong Tao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China.
| | - Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China.
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Risks of major affective disorders following a diagnosis of premenstrual dysphoric disorder: A nationwide longitudinal study. Asian J Psychiatr 2023; 79:103355. [PMID: 36481566 DOI: 10.1016/j.ajp.2022.103355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022]
Abstract
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.
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Slyepchenko A, Minuzzi L, Frey BN. Comorbid Premenstrual Dysphoric Disorder and Bipolar Disorder: A Review. Front Psychiatry 2021; 12:719241. [PMID: 34512419 PMCID: PMC8423998 DOI: 10.3389/fpsyt.2021.719241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Bipolar disorder (BD) differs in its clinical presentation in females compared to males. A number of clinical characteristics have been associated with BD in females: more rapid cycling and mixed features; higher number of depressive episodes; and a higher prevalence of BD type II. There is a strong link between BD and risk for postpartum mood episodes, and a substantial percentage of females with BD experience premenstrual mood worsening of varying degrees of severity. Females with premenstrual dysphoric disorder (PMDD)-the most severe form of premenstrual disturbances-comorbid with BD appear to have a more complex course of illness, including increased psychiatric comorbidities, earlier onset of BD, and greater number of mood episodes. Importantly, there may be a link between puberty and the onset of BD in females with comorbid PMDD and BD, marked by a shortened gap between the onset of BD and menarche. In terms of neurobiology, comorbid BD and PMDD may have unique structural and functional neural correlates. Treatment of BD comorbid with PMDD poses challenges, as the first line treatment of PMDD in the general population is selective serotonin reuptake inhibitors, which produce risk of treatment-emergent manic symptoms. Here, we review current literature concerning the clinical presentation, illness burden, and unique neurobiology of BD comorbid with PMDD. We additionally discuss obstacles faced in symptom tracking, and management of these comorbid disorders.
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Affiliation(s)
- Anastasiya Slyepchenko
- Women's Health Concerns Clinic and Mood Disorders Treatment and Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Women's Health Concerns Clinic and Mood Disorders Treatment and Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic and Mood Disorders Treatment and Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Slyepchenko A, Frey BN, Lafer B, Nierenberg AA, Sachs GS, Dias RS. Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study. Acta Psychiatr Scand 2017; 136:473-482. [PMID: 28846801 PMCID: PMC5630503 DOI: 10.1111/acps.12797] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown. AIMS We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD. MATERIALS & METHODS A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria. RESULTS Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001). DISCUSSION The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD. CONCLUSIONS The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.
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Affiliation(s)
- Anastasiya Slyepchenko
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada,Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada
| | - Benicio N. Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada,Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada,Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Andrew A. Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - Gary S. Sachs
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - Rodrigo S. Dias
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Brazil
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McEvoy K, Osborne LM, Nanavati J, Payne JL. Reproductive Affective Disorders: a Review of the Genetic Evidence for Premenstrual Dysphoric Disorder and Postpartum Depression. Curr Psychiatry Rep 2017; 19:94. [PMID: 29082433 DOI: 10.1007/s11920-017-0852-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to review and summarize the literature exploring the genetic basis for premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD). RECENT FINDINGS There is more evidence for a genetic basis for PPD than for PMDD, but only when PPD is defined as beginning in the immediate postpartum time period. Familial, genome-wide linkage and association studies, and candidate gene studies, most in the past 10 years, have examined the genetic etiology of reproductive affective disorders, including PMDD and PPD. The most commonly studied genes include SERT, COMT, MAOA, BDNF, and ESR1 and 2. This qualitative review of the recent literature finds limited evidence so far for the genetic basis for PMDD, with both familial and candidate gene studies having negative or conflicting results. Evidence is stronger for the genetic basis for PPD, with positive associations found in family studies and in several genes associated with major depression as well as genes involved in estrogen signaling but only when PPD onset is shortly after delivery. Epigenetic biomarkers on genes responsive to estrogen have also been found to predict PPD. Our findings underscore the need for additional studies with larger samples, as well as the crucial importance of timing in the definition of PPD for genetic studies.
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Affiliation(s)
- Katherine McEvoy
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Lauren M Osborne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Julie Nanavati
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Jennifer L Payne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA.
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Aperribai L, Alonso-Arbiol I, Balluerka N, Claes L. Development of a screening instrument to assess premenstrual dysphoric disorder as conceptualized in DSM-5. J Psychosom Res 2016; 88:15-20. [PMID: 27521647 DOI: 10.1016/j.jpsychores.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed at developing and validating a screening instrument to assess premenstrual dysphoric disorder (PMDD) based on DSM-5 criteria, which is not yet available. METHODS The Premenstrual Dysphoric Disorder Questionnaire for DSM-5 (Cuestionario del Trastorno Disfórico Premenstrual - DSM-5), a 25-item questionnaire to assess PMDD was developed and completed in Spanish by 2820 women (Age M=23.43; SD=7.87). Exploratory factor analysis (N=1410) and confirmatory factor analysis (N=1410) were performed in randomly selected subsamples. Empirical evidence of construct validity was obtained via a multitrait-multimethod approach (N=118). Additional validity evidence was provided by associating PMDD with Neuroticism. Internal consistency and test-retest reliability were checked. RESULTS Exploratory and confirmatory factor analyses yielded a bi-dimensional structure. The first dimension, called Dysphoria, included dysphoric symptoms and weight gain; the second dimension, Apathy, referred to apathetic and physical symptoms. Both dimensions displayed good internal consistency coefficients (Dysphoria's ordinal alpha=0.88; Apathy's ordinal alpha=0.84), and moderate temporal stability. The multitrait-multimethod analysis showed that convergent coefficients were higher than discriminant coefficients. Furthermore, a positive relationship between Neuroticism and PMDD was observed. CONCLUSION These findings suggest that the instrument is valid and reliable to assess PMDD.
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Affiliation(s)
- Leire Aperribai
- Department of Educational Psychology and Pedagogy, Begoñako Andra Mari Teacher Training University College, BAM, Bilbao, Spain.
| | - Itziar Alonso-Arbiol
- Department of Psychology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Nekane Balluerka
- Department of Psychology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Teatero ML, Mazmanian D, Sharma V. Effects of the menstrual cycle on bipolar disorder. Bipolar Disord 2014; 16:22-36. [PMID: 24467469 DOI: 10.1111/bdi.12138] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Several lines of research suggest that reproductive events may affect the course of bipolar disorder (BD) in some women. With respect to the menstrual cycle, the focus has been on dysphoric symptoms [e.g., premenstrual dysphoric disorder (PMDD)], and the exacerbation of depression, in the premenstrual phase. This article reviews the literature on the potential effects of the menstrual cycle on BD. METHODS A systematic search for published case reports and research studies available through March, 2013 was conducted. Several combinations of search terms were entered into PubMed and PsycInfo. RESULTS Overall, 25 case reports, ten retrospective studies, and 11 prospective studies were identified. The majority (64%) of case reports involved hypomanic or manic episodes in the premenstrual phase. Retrospective results suggest that 25-77% and 15-27% of women with BD meet the criteria for premenstrual syndrome (PMS) and PMDD, respectively. Menstrual cycle-related mood changes were reported by 64-68% of women with BD in retrospective studies, and were displayed by 44-65% of women in prospective studies. CONCLUSIONS Although research has focused on the premenstrual phase to the neglect of the periovulatory phase, it appears that a subgroup of women with BD, possibly those with hormonal sensitivity, experience menstrual cycle effects on depressive, hypomanic, and manic episodes. These phase-episode effects appear to be heterogeneous and may have implications for treatment. Whether they might best be described using course specifiers, similar to postpartum onset and rapid cycling, or as diagnostic entities, like PMDD, requires further study.
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Affiliation(s)
- Missy L Teatero
- Health, Hormones, & Behaviour Laboratory, Department of Psychology, Lakehead University, Thunder Bay
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Cirillo PC, Passos RBF, Bevilaqua MCDN, López JRRA, Nardi AE. Bipolar Disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder Comorbidity: A Systematic Review. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 34:467-79. [DOI: 10.1016/j.rbp.2012.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/25/2012] [Indexed: 10/27/2022]
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Nguyen TV, Low NCP. Hormonal Treatments for Bipolar Disorder: A Review of the Literature. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jbbs.2012.21006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Cyclical mood disorders characterized by shifting affective states include bipolar disorder, seasonal affective disorder, and premenstrual syndrome/premenstrual dysphoric disorder. In this article, we explore the relationship between these disorders and bring the reader up to date on the advances made in the past year in understanding the relationship between bipolar disorder, seasonality, and premenstrual symptoms.
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Miller A, Vo H, Huo L, Roca C, Schmidt PJ, Rubinow DR. Estrogen receptor alpha (ESR-1) associations with psychological traits in women with PMDD and controls. J Psychiatr Res 2010; 44:788-94. [PMID: 20172536 PMCID: PMC2948969 DOI: 10.1016/j.jpsychires.2010.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/07/2010] [Accepted: 01/26/2010] [Indexed: 11/19/2022]
Abstract
Premenstrual Dysphoric Disorder (PMDD) is a mood disorder affecting about 5% of women and is associated with substantial morbidity. Albeit inconsistently, PMDD is described as being characterized by heritable personality traits. Although PMDD is a heritable disorder, it is unclear whether any of the heritable susceptibility to PMDD resides in heritable personality traits. In groups of carefully characterized women with PMDD (n=68) and controls (n=56), we attempted to determine whether diagnosis-related traits could be confirmed, as well as to determine whether such traits were associated with SNPs in estrogen receptor alpha (ESR-1) that we previously demonstrated were associated with PMDD. We observed 7/25 traits to be significantly different in patients and controls and further showed that 11/12 significant associations observed between these 7 traits and 16 ESR-1 SNPs involved the intron 4 SNPs previously shown to be the locus of the association with PMDD. While several interactions between genotype and diagnosis were observed, the effect of genotype in most instances was in the same direction in patients and controls. These data demonstrate affective state-independent personality traits that distinguish patients with PMDD from controls and further support the relevance of ESR-1 polymorphic variants in the regulation of non-reproductive behaviors.
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Affiliation(s)
- Alexandra Miller
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, United States
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Soares CN. DSM-V and reproductive-related psychiatric disorders: a closer look at windows of vulnerability. Arch Womens Ment Health 2010; 13:15-6. [PMID: 20127446 DOI: 10.1007/s00737-009-0116-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Claudio N Soares
- Departments of Psychiatry and Behavioural Neurosciences and Obstetrics & Gynecology, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
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