Premenstrual syndrome

Differentiate between premenstrual syndrome and premenstrual dysphoric disorder with respect to pathophysiology, clinical presentation, and treatment. 

Premenstrual syndrome (PMS) is a constellation of symptoms including mild mood disturbance and physical symptoms that occur prior to menses and resolve with initiation of menses. It is estimated that up to 70% of menstruating women experience symptoms of PMS. However, a spectrum of premenstrual mood disturbances exists and the most severe is premenstrual dysphoric disorder (PMDD). Approximately 4% to 7% of women have PMDD. A summary of the American Psychiatric Association s criteria for PMDD is as follows1,21 ... 

TREATMENT PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER... 

Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Primary and secondary dysmenorrhea and premenstrual syndrome Etiology, diagnosis, and management. In Stenchever MA, ed. Comprehensive Gynecolgy. 4th ed. St. Louis Mosby 2001 1065-1078. 

Premenstrual syndrome A constellation of symptoms including mild mood disturbance, and physical symptoms that occur prior to menses, and resolve with initiation of menses. 

Schellenberg R. Treatment for the premenstrual syndrome with Agnus castus fruit extract prospective, randomised, placebo controlled study. BMJ 2001 322 134-137. 

Determining the division between normal and abnormal behavior has historically been a difficult task. Some of the more recently debated diagnoses include homosexuality (Spitzer, 1973), self-defeating personality disorder, sadistic personality disorder (Holden, 1986), and premenstrual syndrome (DeAngelis, 1993). Some have argued that these difficulties stem from a failure to adequately define mental illness (Gorenstein, 1984). 

Baker, E. R., Best, R. G., Manfredi, R. L., Demers, L. M., and Wolf, G. C. 1995. Efficacy of progesterone vaginal suppositories in alleviation of nervous symptoms in patients with premenstrual syndrome. Journal of Assisted Reproduction and Genetics 12 205-209. 

Block, N., Schmidt, P. J., and Rubinow, D. R. 1996. Clinical aspects of premenstrual syndrome. Infertility and Reproductive Medicine Clinics of North America 7 315—329. 

Calcium taken daily may help reduce typical premenstrual syndrome (PMS) symptoms such as bloating, cramps, fatigue, and moodiness. 

Symptoms of premenstrual syndrome (PMS) have been relieved at a dosage of 25 mg 4 times daily beginning on day 14 of the menstrual cycle. 

Danazol Synthetic androgen. Suppresses gonadotrophin production. Exhibits some weak androgenic activity Oral administration in the treatment of endometriosis, benign breast disorders, menorrhagia, premenstrual syndrome and hereditary angioedema... 

The selective partial 5-HTia agonist buspirone is used in the therapy of anxiety and premenstrual syndrome. Buspirone has a slow onset of action (1-2 weeks) and is devoid of sedation and physical or psychological dependence. It is used as an alternative for benzodiazepines. 

The disadvantages of these phased combinations are fluid retention, poor relief of dysmenorrhoea and the premenstrual syndrome and a relatively high medication error rate. 

Extreme clinical examples of androgen excess include central precocious puberty, the adrenogenital syndromes, and androgen-secreting adrenal, ovarian, or testicular tumors. Less severe problems include idiopathic hirsutism, premenstrual syndrome, and severe cystic acne. 

Other suggested uses include sexual dysfunction secondary to selective serotonin reuptake inhibitors (SSRIs), macular degeneration, premenstrual syndrome, and the prevention of acute mountain sickness at high altitude. Some of these uses are supported only by a single study. 

Sayegh, R., Schiff, L, Wurtman, J., Spiers, P., McDermott, J., and Wurtman, R. (1995). The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstet. Gynecol. 86(4 Pt 1), 520-528. 

As other indications are sought for the SSRls, it is clear that their action extends beyond depression, dysthymia, and the anxiety disorders, and the broad spectrum of therapeutic action of these antidepressants becomes apparent. For example, based on the evidence from placebo-controlled studies [A. Wood 1993], fluoxetine has been licensed in Europe for the treatment of bulimia, and several SSRls are reported to be effective in the treatment of premenstrual syndrome. 

Denicoff KD, Smith-Jackson E, Disney E, et al Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in the treatment of bipolar affective illness. J Chn Psychiatry 58 470-478, 1997 DeNinno MP, Schrenleber R, Mackenzie R, et al A68930 a potent agonist selective for the dopamine Dj receptor. Eur J Pharmacol 199 209-219, 1991 Dennerstein L, Spencer-Gardner C, Gotts G, et al Progesterone and the premenstrual syndrome a double-blind cross-over trial. BMJ 290 1617-1621, 1985... 

Giannini AJ, Melemis SM, Martin DM, et al Symptoms of premenstrual syndrome as a function of beta-endorphin two subtypes. Prog Neuropsychopharmacol Biol Psychiatry 18 321-327, 1994... 

Halbreich U Premenstrual syndromes, in Psychiatric Issues in Women [Bailliere s International Glinical Psychiatry), Vol 2. Edited by Halbreich U. London, Tindall, 1996, pp 667-686... 

Jacobsen FM Low-dose valproate a new treatment for cyclothymia, mild rapid cycling disorders, and premenstrual syndrome. J Clin Psychiatry 54 229-234, 1993... 

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