The effect of manipulated information about premenstrual changes on the report of positive and negative premenstrual changes

A DSM-5-based tool to monitor concurrent mood and premenstrual symptoms: the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS)

Background

Despite high co-morbidity between premenstrual dysphoric disorder and mood disorders, there is a gap of research-based tools to monitor concurrent premenstrual and mood symptoms. In this study, we developed a new DSM-5-based questionnaire to prospectively monitor concurrent premenstrual and mood symptoms.

Methods

Fifty-two females with bipolar or major depressive disorder, ages 16–45, were enrolled in the study. Participants completed two months of prospective symptom charting including the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS) and the Daily Record of Severity of Problems (DRSP). At the end of the prospective charting, participants also completed the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). The MAC-PMSS was correlated with the DRSP, MADRS, HDRS and YMRS.

Results

All individual items of the MAC-PMSS correlated strongly with the individual DRSP scores (all p < 0.001). The mood section of the MAC-PMSS also significantly correlated with MADRS (r = 0.572; p < 0.01), HDRS (r = 0.555; p < 0.01) and YMRS scores (r = 0.456; p < 0.01).

Conclusions

The MAC-PMSS is a reliable to tool to measure concurrent mood and premenstrual symptoms in women with mood disorders.

Internet-Based Cognitive-Behavioural Intervention for Women with Premenstrual Dysphoric Disorder: A Randomized Controlled Trial

BACKGROUND

Given the high prevalence of clinically relevant premenstrual symptoms and the associated impairment, there is a need for effective treatments. Initial evidence suggests cognitive-behavioural therapy (CBT) as an effective treatment for premenstrual dysphoric disorder (PMDD). The aim of the current randomized clinical trial was to evaluate an Internet-based CBT (iCBT) to reduce the burden of PMDD.

METHODS

In all, 174 women with PMDD were recruited via newspaper articles, flyers, and social media. They were randomized to a treatment group (TG; n = 86) or waitlist control group (CG; n = 88). Women of the TG received an 8-week therapist-guided iCBT. Data were assessed before and after treatment/waiting, and 6 months after intervention with prospective symptom diaries and questionnaires in the premenstrual phase. Treatment effects and moderators were analysed using hierarchical linear modelling.

RESULTS

Significant time × group interaction effects on functional impairment and psychological impairment, impact on everyday life, symptom intensity, and symptom disability in favour of the TG indicated the efficacy of the treatment. Follow-up assessments demonstrated treatment effects to be stable until 6 months after treatment. Additionally, significant interactions with moderator variables were found. In the TG, higher levels of active coping and lower levels of support-seeking coping were associated with stronger improvement in interference in everyday life and symptom intensity. In addition, lower levels of perceived stress were associated with stronger improvement in functional impairment.

CONCLUSION

The iCBT was highly effective in reducing the burden of PMDD. It appears to be particularly important to address coping styles and stress management in the treatment.

Clusters of premenstrual symptoms in women with PMDD: Appearance, stability and association with impairment

Although premenstrual dysphoric disorder (PMDD) is assumed to be a homogenous diagnostic entity, it is hallmarked by highly diverse clinical symptoms. In this study, we investigate symptom clusters in women prospectively diagnosed with severe premenstrual syndrome (PMS) or PMDD using factor analysis; analyze the stability of the structures of different symptom patterns and their association with impairment at work, in recreation, and in relationships. A total of 174 prospective symptom diaries were analyzed with principal axis factoring revealing six clusters named affective dysphoria, somatic dysphoria, irritability, breast/body sensitivity, pain, and eating behavior. Cronbach's alpha was good for all clusters (0.83 to 0.91) with the exception of the cluster pain (0.69). Clusters of symptoms appeared to be stable between two consecutive menstrual cycles (except of pain and eating behavior) and between two cycles with a waiting period of eight weeks in between. Multiple regression analyses showed different associations of the clusters with impairment. Somatic dysphoria was the cluster most strongly associated with impairment. The results indicate that in severe PMS/PMDD, different symptom patterns should be considered. As the risk of impairment differs between symptom clusters, individual treatment options should be considered and further investigated in research and treatment.