Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges

Efficacy and Safety of Ganyushu Granule in Treatment of Premenstrual Syndrome with Gan (Liver) Depression and Qi Stagnation Syndrome: A Randomized, Double-Blind, Multi-Center, Phase-II Clinical 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 phase III trial. (Registration No. ChiCTR1800016595).

Associations with physical activity, sedentary behavior, and premenstrual syndrome among Chinese female college students

PURPOSE

Premenstrual syndrome refers to a set of distressing symptoms experienced before the menstrual flow, which can affect female students' behavior, cognitive abilities, mental health status, and academic performance. Identifying modifiable risk factors is essential to reduce the prevalence college students' premenstrual syndrome. We examined associations between premenstrual syndrome and physical activity and sedentary behavior in Chinese female college students.

METHODS

In this cross-sectional study, 315 female college students volunteered to participate at a university in Shanghai, China. We measured physical activity and sedentary behavior using the ActiGraph GT3X-BT and assessed premenstrual syndrome using the Premenstrual Symptoms Screening Tool. The data were statistically analyzed using SPSS 24.0 software, and the primary analysis methods included Kruskal-Wallis test and logistic regression analysis.

RESULTS

Among the 221 female college students who met the inclusion criteria, 148 (67.0%) had PMS while 73 (33.3%) did not. After controlling for confounding variables, moderate physical activity and moderate to vigorous intensity physical activity were significantly associated with premenstrual syndrome. There was no correlation between light-intensity physical activity, sedentary behavior, and premenstrual syndrome in the study.

CONCLUSION

Premenstrual syndrome is prevalent among Chinese female college students. Moderate physical activity and moderate-to-vigorous physical activity can be effective in reducing PMS symptoms.

Factors associated with the severity of premenstrual symptoms in women with central obesity: a cross-sectional study

INTRODUCTION

Premenstrual syndrome (PMS) is a common condition that affects social and psychological well-being of women. The risk of PMS is higher among obese women. The aim of this study was to identify the factors that influence the severity of PMS in women with central obesity.

MATERIALS AND METHODS

This cross-sectional study was performed on 30-50 year-old women with abdominal obesity (waist circumference > 80 cm). The following data were collected: demographic data, anthropometric measurements, premenstrual symptoms screening tools, semi-quantitative food frequency questionnaire, 42-item depression, anxiety, and stress questionnaire (DASS-42), as well as serum vitamin D, and renal function tests.

RESULTS

A total of 139 women (mean age of 41.40 ± 7.39 years old) participated in the study. The prevalence of mild, moderate and severe premenstrual symptoms was 38.7% (55/142), 31.7% (45/142) and 27.5% (39/142), respectively. There was no significant difference between the groups in terms of anthropometric measurements and energy-adjusted nutrient intakes (p > 0.05). There was a significant relationship between moderate PMS and energy-adjusted saturated fatty acid (SFA) (p = .018, OR = .010 and 95% CI for OR: < .001 and .452), and energy-adjusted riboflavin (p = .042, OR = .005, 95% CI for OR: < .001 and .821), and between severe PMS and age (p = .034, OR = .906, 95% CI for OR: .826 and .993), and energy-adjusted monounsaturated fatty acid (MUFA) intake (p = .041, OR = 23.789, 95% CI for OR: 1.138 and 497.294).

CONCLUSION

High intakes of MUFA and younger age were associated with a greater severity of PMS, while riboflavin intake was associated with reduced PMS severity.

Case Report of Premenstrual Dysphoric Disorder with a Brief Psychotic Episode

BACKGROUND: Premenstrual Dysphoric Disorder (PMDD) is often neglected because people see it as a normal condition due to hormonal changes in women's bodies. Prevalence of women experiencing PMDD is estimated to be around 3% -9% in the population, and sometimes, this condition could be so severe that it negatively impacts the affected’s life and family.1   CASE PRESENTATION: A 15 years old girl was brought by her parents to the department of psychiatry, general hospital of USU with an odds attitude. She repeatedly said ‘nenek, nek, nenek’ and claimed that she saw her grandmother who was already dead since five years. Co-occurring with these symptoms, she has also had a terrible premenstrual syndrome since menarche. In her premenstrual days, she complains about her stomach cramps, tender breast and back pain. In addition, she was reported to be uncontrollably angry and sad. These symptoms usually developed 2-3 days before menstruation and regressed without residues in menstruation days.   CONCLUSION: A 15 years old diagnosed with premenstrual dysphoric disorder (PMDD), which occurred since menarche. Brief psychotic episodes were found with every PMDD cycle in these three month. This brief psychotic episode is still under observation. 

Mood Swing during Menstruation: Confounding Factors and Drug Use

Background

Premenstrual syndrome (PMS) is a physiologic process in women where mood swing is one of the symptoms influencing the psycho-emotional, physical, and behavioral reactions exhibited by women during menstruation. This study elucidates the effect of mood swing, confounding factors and healthcare-seeking behaviors of women in an educational environment.

Methods

Exactly 328 women who were within reproductive ages 16 and 35 years participated in this study. A survey method was adopted; validated and standardized questionnaires were administered to confidentially assess the effect of mood swing via PMS. All data were analyzed with SPSS 25.0; descriptive method was adopted and results were expressed in percentages.

Results

Mood swing was discovered as a symptom overlapping with psycho-emotional, physical, and behavioral symptoms during menstruation. The overall PMS prevalence was 67.4% while PMDD prevalence was 25.6%. Psycho-emotional symptoms: anger, irritability, depression. Physical symptoms: coldness, paleness, food craving, breast tenderness, digestive changes. Behavioral symptoms: social withdrawal, nocturnal social activity, absenteeism, poor work or academic performance, increased libido. Confounding factors include stress, gynecological conditions such as endometriosis, uterine fibroid, ovarian cyst, pelvic adhesion, and polycystic ovarian syndrome. Also, 22.9% had a family history of bipolar disorder (BD) while 30.2% had previous diagnosis. Severe pain was a major factor for seeking treatment; Paracetamol, and Piroxicam were frequently used drugs.

Conclusions

Severe PMS triggers mood swing and can badly affect academic or work activities; victims either endure the pain due to socio-cultural and financial factors or take unsuitable medications where abuse is inevitable.

Top 100 Cited Papers on Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Bibliometric Study

BACKGROUND

Premenstrual syndrome/premenstrual dysphoric disorder is a serious condition affecting women worldwide, causing clinically significant distress or interference. Therefore, solving these diseases has become the utmost concern worldwide, culminating in numerous studies. In this study, we performed bibliometric analysis on the 100 most cited papers with the aim of identifying research hot spots and trends in this field.

METHODS

We screened the Science Citation Index Expanded (SCIE) of Web of Science (WOS) to identify the top 100 cited studies on PMS/PMDD. Next, we analyzed relevant literature from various journals, countries/regions, institutions, authors, and keywords. Finally, we used VOSviewer and Citespace software to generate knowledge maps and identify hot spots and trends.

RESULTS

The top 100 highly cited studies were published in 55 journals, between 1999 and 2017, across 24 countries/regions around the world. Most articles were published in Obstetrics and Gynecology, whereas Psych neuroendocrinology had the largest average number of citations per paper. The United States had the highest number of publications, followed by England, Canada, and Sweden. The top three institutions that published the highly cited literature were the University of Pennsylvania, Yale University, and National Institute of Mental Health (NIMH). Obstetrics, Gynecology, Psychiatry, and Reproductive Biology were the main research directions, whereas the top 10 Co-occurrence of Keywords included double-blind, fluoxetine, efficacy, prevalence, epidemiology, phase sertraline treatment, depression, progesterone, placebo, and placebo-controlled trial. Results from cluster analysis indicated that more comprehensive epidemiology and steroid pathogenesis have gradually become the hot spots and trends.

CONCLUSION

These findings demonstrated that bibliometric analysis can intuitively and rapidly reveal the frontiers and hot spots of research in PMS/PMDD. Notably, epidemiology, steroid pathogenesis, GABAA receptor delta subunits, and double-blind placebo-controlled trials are potential areas of focus for future research.

Bipolar disorder: Treatment strategies for women of childbearing age

PURPOSE

Bipolar disorder is associated with increased rates of morbidity and mortality, magnified in women of childbearing age. The purpose of this paper is to provide an overview of the differential diagnosis and management of bipolar disorder in women of childbearing age.

CONCLUSIONS

Differential diagnoses for bipolar disorder include depressive disorders, anxiety disorders, trauma-related disorders, attention-deficit/hyperactivity disorder, and personality disorders. Pharmacotherapeutic options for the treatment of bipolar disorder include lithium, anti-epileptic medications, and atypical antipsychotics. In regard to women of childbearing age, consideration of risks, benefits, and alternative therapies is needed before initiating therapy.

PRACTICE IMPLICATIONS

Caring for patients with bipolar disorder, particularly women of childbearing age, requires careful differentiation of bipolar disorder from other mental health problems, and prudent consideration of pharmacotherapeutic options.

Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps

PURPOSE OF REVIEW

In contrast to premenstrual dysphoric disorder (PMDD), premenstrual exacerbations (PMEs) of ongoing mood disorders are understudied. The aim of this review is to describe diagnostic issues, epidemiology, underlying mechanisms, and treatment for PME in unipolar depression and bipolar disorder, and to discuss clinical and research implications.

RECENT FINDINGS

Community-based and clinical studies estimate that in women with mood disorders around 60% report PME, while some women with bipolar disorder also show symptom exacerbations around ovulation. In general, PME predicts a more severe illness course and an increased burden. While heightened sensitivity to fluctuations of sex hormone levels across the menstrual cycle appears to contribute to PME and PMDD, the overlap of their underlying biological mechanisms remains unclear. Beneficial treatments for PMDD show less or no efficacy in PME. Pharmacological treatments for PME in mood disorders predominantly seem to profit from adjustable augmentation of treatment dosages during the luteal phase for the underlying disorder. However, the evidence is sparse and mainly based on earlier small studies and case reports. Previous research is mainly limited by the lack of a clear differentiation between PME and PMDD comorbidity with mood disorders. More systematic research with uniformly defined and prospectively assessed subgroups of PME in larger epidemiological and clinical samples is needed to receive reliable prevalence estimates and information on the clinical impact of PME of mood disorders, and to uncover underlying mechanisms. In addition, larger randomized controlled trials are warranted to identify efficacious pharmacological and psychotherapeutic treatments for affected women.

Are premenstrual syndrome and dysmenorrhea related to the personality structure of women? A descriptive relation-seeker type study

PURPOSE

This study was conducted to define the relationship of experiencing premenstrual syndrome (PMS) and dysmenorrhea with the personality structure of women.

DESIGN AND METHODS

The sample of this descriptive relation-seeker-type study comprised 353 women. Data were collected using the PMS Scale, Quick Big Five Personality Test, and The Questionnaire Form between 1 April and 31 August 2019 in a city in the Mediterranean region in Turkey.

FINDINGS

There was a weak negative-biased correlation between PMS and extraversion, a very weak negative-biased correlation between PMS and conscientiousness, a moderate negative-biased correlation between PMS and neuroticism, and a very weak positive-biased significant correlation between PMS and openness (P < .05).

PRACTICE IMPLICATIONS

These data suggest that women who are introverted, have weak self-confidence, tend to have negative feelings such as anxiety, depression, and anger, and have weak coping skills are at risk for experiencing PMS.