Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs.
ABSTRACT The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains. Several treatment modalities are beneficial in PMDD and severe PMS, but the selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. The SSRIs can be administered continuously throughout the entire month, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. These guidelines present practical treatment algorithms for the use of SSRIs in women with pure PMDD or severe PMS, PMDD and underlying subsyndromal clinical features of mood or anxiety, or premenstrual exacerbation of a mood/anxiety disorder.
The Journal of Clinical Psychiatry 10/2013; 74(10):1018-1021. DOI:10.4088/JCP.13com08742 · 5.14 Impact Factor
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ABSTRACT: Representations of premenstrual syndrome (PMS) in Western scientific and popular discourse construct premenstrual change as a disorder and portray premenstrual women as out-of-control, emotionally unstable, and dangerous. Previous research has suggested that the adoption of such constructions of PMS by male partners can have a deleterious influence on women’s experiences of premenstrual distress. However, few studies to date have examined constructions of PMS and the function of such constructions within men’s talk. Representations of PMS and premenstrual women in men’s accounts in the online discussion forum PMSBuddy.com, which appeared between September 2008 and February 2009, were analyzed through a thematic discourse analysis. The majority of accounts positioned negative premenstrual change as a hormonal disorder, an excuse, or a nuisance. Some men described themselves as victimized by their premenstrual partners, and positioned their experiences as unfair and undeserved. A small portion of men talked positively about premenstrual women and emphasized the importance of providing support. These findings suggest that it is important to recognize that PMS is constructed and experienced in a relational context. Cultural and relational constructions of PMS can influence both men and women’s experiences of premenstrual change.07/2014; 1(1):3-20. DOI:10.1080/23293691.2014.901796
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ABSTRACT: Negative premenstrual change can result in distress for a significant proportion of women. Previous research has suggested that women employ a range of coping strategies and behaviours in order to manage and reduce premenstrual distress. However, as yet there has been no specific scale available to measure premenstrual coping. This research aimed to develop and validate a measure of premenstrual coping which can be used in future investigations of negative premenstrual experience. A sample of 250 women living in Australia, reporting mild to severe premenstrual distress, completed an online survey containing 64 items related to premenstrual coping. The items were generated by reviewing past literature related to premenstrual experience, in particular recent qualitative research on premenstrual coping. A principal components factor analysis with varimax rotation was conducted to determine item clusters that would form a measure. Reliability and validity were tested using calculations of Cronbach alphas, correlational analysis with psychological coping scales and a content analysis of participant reports of coping strategies. The factor analysis, which involved two principal component analyses, resulted in five factors containing 32 premenstrual coping behaviours. Interpretation of the factor solution drew on empirical and theoretical accounts of premenstrual coping and the emergent factors were labelled Avoiding Harm, Awareness and Acceptance of Premenstrual Change, Adjusting Energy, Self-Care, and Communicating. These factors form the subscales of thePremenstrual Coping Measure (PMCM). The subscales demonstrated acceptable to very good reliability and tests of construct, concurrent and content validity were supportive of sound validity. The PMCM provides a valid and reliable scale for quantifying ways of coping specific to negative premenstrual change. Conceptual similarity was found between some coping behaviours and behaviours positioned as symptoms of premenstrual change. Explanations for this overlap may be found in cultural discourses associated with idealised femininity and PMS (premenstrual syndrome). Further psychometric investigation of the PMCM will enhance knowledge of the role of coping with negative premenstrual experience.BMC Women's Health 01/2014; 14(1):1. DOI:10.1186/1472-6874-14-1 · 1.66 Impact Factor