Psychiatric symptoms and disorders associated with reproductive cyclicity in women: advances in screening tools

Validation of the premenstrual symptoms questionnaire among Mongolian nursing school students

BACKGROUND

Premenstrual disorders (PMDs) significantly affect the daily lives of women. This study evaluated the reliability and validity of the Mongolian-translated Premenstrual Symptoms Questionnaire (PSQ) among female nursing students at the Mongolian National University of Medical Sciences.

METHODS

This cross-sectional study was conducted from February 2023 to January 2024. The PSQ was translated into Mongolian, and its reliability and validity were assessed. A total of 431 participants completed the translated PSQ along with the Premenstrual Dysphoric Disorder (PMDD) Scale, Somatic Symptom Scale (SSS-8), Patient Health Questionnaire (PHQ-9), and Beck Anxiety Inventory (BAI). Reliability was evaluated via Cronbach's alpha for internal consistency. Validity was assessed via factor analysis and correlations with external measures.

RESULTS

The internal consistency of the Mongolian PSQ was 0. 945. Factor analysis supported the tool's construct validity, which revealed a one-factor structure consistent with that of the original Japanese PSQ. The PSQ had strong positive correlations with the PMDD Scale (r = 0.760), SSS-8 (r = 0.640), PHQ-9 (r = 0.580), and BAI (r = 0.620), which indicated good convergent validity.

CONCLUSION

The Mongolian-translated PSQ is a reliable and valid tool for assessing premenstrual symptoms in female nursing students. These findings suggest that the PSQ is a useful tool for screening PMDs in this population.

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.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder as Centrally Based Disorders

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) encompass a variety of symptoms that occur during the luteal phase of the menstrual cycle and impair daily life activities and relationships. Depending on the type and severity of physical, emotional or behavioral symptoms, women of reproductive age followed for at least two prospective menstrual cycles may receive one of the two diagnoses. PMDD is the most severe form of PMS, predominantly characterized by emotional and behavioral symptoms not due to another psychiatric disorder. PMS and PMDD are common neuro-hormonal gynecological disorders with a multifaceted etiology. Gonadal steroid hormones and their metabolites influence a plethora of biological systems involved in the occurrence of specific symptoms, but there is no doubt that PMS/PMDD are centrally based disorders. A more sensitive neuroendocrine threshold to cyclical variations of estrogens and progesterone under physiological and hormonal therapies is present. Moreover, altered brain sensitivity to allopregnanolone, a metabolite of progesterone produced after ovulation potentiating GABA activity, along with an impairment of opioid and serotoninergic systems, may justify the occurrence of emotional and behavioral symptoms. Even neuro-inflammation expressed via the GABAergic system is under investigation as an etiological factor of PMS/PMDD. Pharmacological management aims to stabilize hormonal fluctuations and to restore the neuroendocrine balance. The rationale of suppressing ovulation supports prescription of combined hormonal contraception (CHC). Its effect on mood is highly variable and depends on biochemical characteristics of exogenous steroids and on type and severity of symptoms. Hormonal regimens reducing the estrogen-free interval or suppressing menstruation seem better choices. Psychoactive agents, such as serotonin reuptake inhibitors (SSRIs), are effective in reducing the symptoms of PMS/PMDD and may be prescribed continuously or only during the luteal phase. Novel therapeutic approaches include inhibition of progesterone receptors in the brain, i.e., with ulipristal acetate, reduced conversion of progesterone with dutasteride, and modulation of the action of allopregnanolone on the brain GABAergic system with sepranolone.

Premenstrual dysphoric disorder and childhood maltreatment, adulthood stressful life events and depression among Lebanese university students: a structural equation modeling approach

BACKGROUND

Premenstrual Syndrome (PMS) is a cyclic sequence of physical and behavioral symptoms that arise in the second half of the menstrual cycle. The extreme type of PMS is Premenstrual Dysphoric Disorder (PMDD). The current study aims at examining 1) the effects of childhood maltreatment and current life's stressful events on PMDD, and 2) the mediating role of depression in these associations among Lebanese university female students.

METHODS

This cross-sectional study was conducted between February and March 2021 during the COVID-19 pandemic. Lebanese students were recruited using a snowball technique from all national universities in Lebanon via an auto-administrated online survey. Structural equation modeling was performed to examine the structural relationship between childhood maltreatment and life's stressful events, depression and PMDD.

RESULTS

Higher life's stressful events (Beta = 0.18; p < 0.001), physical (Beta = 0.19; p < 0.001), sexual (Beta = 0.18; p < 0.001) and psychological (Beta = 0.33; p < 0.001) abuse were significantly associated with higher depression. Moreover, higher sexual (Beta = 0.11; p = 0.021) and psychological (Beta = 0.11; p = 0.040) abuse and higher depression (Beta = 0.37; p < 0.001) were significantly associated with higher PMDD. The indirect relationships between psychological abuse/sexual abuse, depression and PMDD showed that depression mediated the association between both psychological (Beta = 0.22; p = 0.001) and sexual (Beta = 0.38; p = 0.004) abuse and PMDD.

CONCLUSION

This work presents a unique analysis using the structural equation model that enlightens the effect of childhood maltreatment, particularly sexual and psychological abuse on PMMD symptoms, with depression playing the role of a mediating factor. It would be interesting to test, in future studies, whether there are other mediating factors besides depression that could be indirect indicators of PMDD.

Reduction of quality-adjusted life years (QALYs) in patients with premenstrual dysphoric disorder (PMDD)

PURPOSE

Premenstrual dysphoric disorder (PMDD) refers to the depression that occurs during the premenstrual phase and remits soon after the onset of menses. It affects the quality of life (QOL) of patients with PMDD. Therefore, this preliminary survey from chart recordings aimed to understand the symptom appearance and QOL reduction patterns in patients with PMDD, and to examine the extent of the loss of their quality-adjusted life years (QALYs).

METHODS

Participants were 66 untreated female patients with PMDD. Data on symptom appearance and QOL reduction during the menstrual cycle, and the EuroQoL-5D (EQ-5D) scores during the premenstrual phase and immediately after the completion of a menstrual period were collected.

RESULTS

The mean EQ-5D score of the 66 patients with PMDD was 0.795 ± 0.120 (range 0.362-0.949), indicating that their expected mean loss of QALYs was about 0.14 years.

CONCLUSIONS

If untreated, PMDD is expected to cause a mean loss of QALYs of about 0.14 years. However, on accounting for the period from disease development to menopause, and subtracting the menstruation-free periods such as pregnancy and breastfeeding, patients with untreated PMDD are expected to experience a QALY loss of about 3 years during their lifetime.