premenstrual%20dysphoric%20disorder
PREMENSTRUAL DYSPHORIC DISORDER
Premenstrual dysphoric disorder is a cyclical disorder presenting with distressing mood and behavioral symptoms that occur during the late luteal phase of the ovulatory cycle; it is a severe form of premenstrual syndrome.
It results in considerable impairment of the patient's personal functioning that occurs in approximately 5% of women of reproductive age.

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
    1. Appreciable depressed mood, feeling of hopelessness or self-depreciation
    2. Marked tension, anxiety or feelings “on edge” or “keyed up”
    3. Appreciable affective lability such as sudden sadness or tearfulness or having increased sensitivity to rejection
    4. Continual and marked anger or irritability or increased interpersonal conflicts
    5. Decreased interest in usual activities
    6. Subjective feeling of difficulty in concentrating
    7. Lethargy, marked lack of energy, easy fatigability
    8. Hypersomnia or insomnia
    9. Subjective feeling of being overwhelmed or out of control
    10. Change in appetite, overeating or cravings for certain foods
    11. 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 
  • A one-time screening process using a checklist of common symptoms may be more feasible in clinical practice
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