4: PMS and Dysphoric Disorder Flashcards
When keeping a symptom calendar (for at least 2 cycles), are individual symptoms or symptom clusters recommended?
Symptom clusters
The therapeutic process is dependent on what 6 elements?
- Desired outcome
- Characteristics of the diagnosis
- Evidence-based efficacy of the intervention
- Feasibility of successfully implementing the intervention
- Acceptability and motivation of the woman
- Education and experience of the clinician
Diagnostic criteria of PMDD.
- In the majority of cycles, five or more symptoms, including affective and physical symptoms, are present during the week before menses and are absent in the follicular phase.
- One (or more) of the following symptoms is present: irritability, depressed mood, marked anxiety, tension, or affective lability.
- One or more of the following symptoms must additionally be present (the combination of symptoms in 1 and 2 must total 5): decreased interest in usual activities, difficulty concentrating, fatigue, appetite change (decreased or increased), changes in sleep patterns (hypersomnia or insomnia), sense of feeling overwhelmed, physical symptoms such as breast tenderness, joint or muscle pain, bloating, or weight gain.
- The symptoms markedly interfere with occupational or social functioning.
- The symptoms are not due to an exacerbation of another disorder.
- The preceding criteria have been confirmed by prospective daily ratings over at least two menstrual cycles
Which assessment tool is helpful for PMS and PMDD?
PHQ-9
_____ encompasses cognitive, behavioral, emotional, and negative symptomatic changes that severely impair daily functioning, relationships, parenting, and ability to work in the late luteal menstrual phase.
PMDD encompasses cognitive, behavioral, emotional, and negative symptomatic changes that severely impair daily functioning, relationships, parenting, and ability to work in the late luteal menstrual phase.
Severe PMS with predominantly negative affective symptoms.
Premenstrual dysphoric disorder (PMDD)
T/F Diet, hormones, and behavioral factors probably all play strong roles in its development. Some evidence suggests that psychosocial factors such as early exposure to physical, emotional, and sexual abuse probably contribute to the development of PMS/
True
SAM-e therapy must be taken with what?
- Daily multivitamin
- Diet high in fruits and vegetables
Diagnostic criteria for PMS.
- Symptoms consistent with PMS:
- Affective symptoms
- Depression
- Angry outbursts
- Irritability
- Anxiety
- Confusion
- Social withdrawal
- Somatic symptoms
- Breast tenderness or swelling
- bdominal bloating
- Headache
- Joint or muscle pain
- Weight gain
- Swelling of extremities
- Affective symptoms
- Consistent occurrence of the symptoms only during the luteal phase of the menstrual cycle
- Negative impact of the symptoms on some facet of the woman’s life
- Exclusion of other diagnoses that may better explain the symptoms
When are GI symptoms highest?
During menses
T/F PMS and PMDD are considered mood disorders and appear in the DSM as mental health conditions.
True
_____ can be defined as a cluster of mild to moderate physical and psychological symptoms that occur during the late luteal phase of menses and resolve with menstruation.
PMS can be defined as a cluster of mild to moderate physical and psychological symptoms that occur during the late luteal phase of menses and resolve with menstruation.
Therapeutic options for PMS/PMDD.
- Health-promoting strategies:
- balanced diet
- sufficient exercise
- reducing stress
- cognitive behavioral therapy
- Nonpharm therapies:
- acupuncture
- dietary supplements (calcium, continuous B6, curcumin)
- herbs (vitex / chaste tree, cramp bark, evening primrose oil-little benefit)
- S-Adenosylmethionine (SAM-e) (molecule manufactured by the body from amino acid methionine)
- Pharmacologic:
- SSRIs (fluoxetine, sertraline, paroxetine) (continuous or intermittent)
- Anxiolytics (alprazolam - Xanax is the most popular but others can be used)
- COCs (mostly help with physical symptoms)
- Diuretics (no evidence exists for TZDs and they may worsen symptoms. Spironolactone only one that helps with severe bloating and headaches)
When do menstrual migraines most frequently occur?
1-3 days before menstruation begins or during the first day or 2 of menses, when hormone levels drop significantly.
What is the etiology of PMS and PMDD?
- Although the etiology is not completely understood, women with PMS or PMDD appear to be more physiologically sensitive to normal cycling of estrogen and progesterone.
- Increases in aldosterone and plasma renin activity are the hypothetical mechanisms for fluid retention, weight gain, and bloating.
- Neurotransmitters, particularly serotonin and gamma-amino-butyric acid, also may be involved.
- Studies of PMDD have identified serotonin as a potential causative factor, and this theory has found further confirmation in that serotonin reuptake inhibitors (SSRIs) can be beneficial in treating PMDD.
- Genetic predisposition.
- Dysregulation of serotonergic system.
- Combination of multiple stressors, increased stress response, lack of support, vulnerable period of biologic reactivity.
- Early life abuse.
