Premenstrual%20dysphoric%20disorder Diagnosis
Diagnosis
Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD)
- Presence of ≥1 of the 1st four symptoms and ≥5 of any symptom occurring during the last week of the luteal phase with remission starting within a few days after the onset of menses and absent in the week postmenses
- Appreciable depressed mood, feeling of hopelessness or self-depreciation
- Marked tension, anxiety or feelings “on edge” or “keyed up”
- Appreciable affective lability such as sudden sadness or tearfulness or having increased sensitivity to rejection
- Continual and marked anger or irritability or increased interpersonal conflicts
- Decreased interest in usual activities
- Subjective feeling of difficulty in concentrating
- Lethargy, marked lack of energy, easy fatigability
- Hypersomnia or insomnia
- Subjective feeling of being overwhelmed or out of control
- Change in appetite, overeating or cravings for certain foods
- Physical symptoms (eg breast swelling/tenderness, sensation of bloating/weight gain, joint or muscle pain, headache)
- Appreciable interference with school/work or with usual social activities or relationships with others
- The disturbance is not a mere exacerbation of the symptoms of another disorder (eg major depression, panic disorder)
- Confirmation of the 3 criteria above by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles
- Diagnosis may be provisional prior to confirmation by daily ratings
- The symptoms are not due to the effects of a medication or another medical condition, other treatment, or drug of abuse
Diagnosis and Treatment Strategies
- Take a thorough medical history
- Personal and social history may reveal trauma or sexual abuse
- Patient should record symptoms for 2 menstrual cycles during which lifestyle-related interventions are begun
- May use standardized daily symptom calendars such as the Calendar of Premenstrual Experiences (COPE) or the Daily Record of Severity of Problems
- COPE, developed by the University of California, San Diego (UCSD), is a daily scoring sheet that assigns a severity score to the common physical (eg bloating, swelling, headache, breast tenderness) and behavioral symptoms (eg depression, irritability, confusion, angry outbursts) during the menstrual cycle
- A score of <40 during days 3-9 of the menstrual cycle added with score of >42 during the last 7 days of the cycle has been demonstrated to be a predictor of women meeting inclusion criteria for PMDD
- If patient remains symptomatic after 2 months of charting and lifestyle modifications, then pharmacotherapy should be considered
- If patient with PMS fails pharmacotherapy and has severe symptoms, management by a multidisciplinary team utilizing a holistic approach (eg gynecologist, mental health practitioner, dietician) may be warranted
- May use standardized daily symptom calendars such as the Calendar of Premenstrual Experiences (COPE) or the Daily Record of Severity of Problems
- A one-time screening process using a checklist of common symptoms may be more feasible in clinical practice