Premenstrual syndrome

This paper is an overview of research on premenstrual syndrome (PMS), focusing on the key topics of definition of the syndrome and the relationship of PMS to psychiatric illness. The etiology and treatment of PMS is discussed. Medical-legal implications of PMS are also reviewed with attention directed to the few studies and court cases relating PMS to the concept of diminished criminal responsibility. Researchers are beginning to make some progress with respect to criteria for the diagnosis of PMS. Much work remains concerning the questions of the relationship of PMS to psychiatric disorders and whether PMS should be considered as one syndrome or many.     

Premenstrual syndrom

Premenstrual syndrome is a condition with cyclical mood changes occurring in 30 % of the female population of fertile ages. The symptom development is very closely related to the luteal phase indicating the existence of one or more factors during the luteal phase that provoke mental symptoms in sensitive patients. This is further supported by the fact that hysterectomized women with no menstrual bleedings but with the ovarian hormone cycle continue to show cyclical mood changes without having the cycle phase. The nature of the symptom provocating factor is still unknown but the ovarian hormones progesterone and/or estradiol are suspected. This as certain women taking oral contraceptives and sequential postmenopausal estrogen-progestagen treatment achieve mood changes. Psychological and personality factors are probably also involved, at least in the degree of the mood change and the type of mood experienced.     

Cognitive-Behavioral and Pharmacological Interventions for Premenstrual Syndrome or Premenstrual Dysphoric Disorder: A Meta-Analysis

The current meta-analysis investigates the efficacy of psychotherapeutic interventions and psychopharmacotherapy for premenstrual syndrome (PMS) and premenstrual dysphoric disorder. Based on a multiple-phase literature search, controlled trials were selected according to a priori defined inclusion criteria. Data were extracted on the basis of a standardized coding scheme. The standardized weighted mean difference (random effects model) was used as effect size index. Dependent on outcome, 22 included studies obtained small to medium effect sizes for cognitive-behavioral interventions (range: d (+)?=?0.24-0.70) and for serotonergic antidepressants (range: d (+)?=?0.29-0.58), at post-assessment. Follow-ups were performed only in studies of cognitive-behavioral interventions (range: d (+)?=?0.46-0.74). There was no evidence of a publication bias. For both cognitive-behavioral interventions and serotonergic antidepressants, efficacy in treatment of PMS was found to not be satisfactory. Future research should possibly focus more on a combination of both approaches.     

Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples

Subtyping depression has been an interest of theorists and clinicians for at least four centuries. In this paper, we examined the validity of the symptom cluster component of the hopelessness theory of depression. We used structural equation modeling analyses on large samples of psychiatric outpatients (N=1604, 844, and 680) and Air Force cadets (N=1404) who completed the items of the Beck Depression Inventory (BDI). Findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome. Implications for the nosology of depression and for depression theory were discussed.     

Premenstrual tension and personality

The premenstrual symptomalogy (PMT) of 165 students of nursing and midwifery was studied and their personality was assessed using the Eysenck Personality Questionnaire (EPQ). Thirty-four per cent of the Ss showed severe and 42% moderate PMT symptomatology. Ss with severe PMT symptomatology gave significantly higher scores in the neuroticism scale of the EPQ. Abdominal and pelvic pain as well as low back pain, i.e. symptoms of dysmenorrhoea, did not correlate with high neuroticism scores.     

Premenstrual symptoms: the role of irrational thinking.

104 women, between the ages of 18 and 45 years, were surveyed to investigate the relationship between premenstrual symptomatology, as measured by the Modified Menstrual Distress Questionnaire, and irrational thinking, as measured by the General Attitude and Belief Scale. The women who reported greater premenstrual symptomatology also reported significantly higher scores in the "need for comfort" irrationality subscale. This indicated that these women had particular difficulty dealing with hassles and the resulting feelings of tension and irritability in the premenstruum. It was suggested that the absence of significant effects for other rationality-irrationality subscales could be associated with testing at different times during the menstrual cycle. Irrationality, like other conditions (such as anxiety and depression) prevalent in the premenstruum, could change in intensity across phases of the menstrual cycle.     

Psychotherapist Diagnosis of Premenstrual Syndrome

The authors examined the ability of psychotherapists to diagnose premenstrual syndrome (PMS). They developed two case vignettes that were identical except that symptoms were described as cyclical in one and noncyclical in the other. Participants were asked to provide selected demographic information and requested to make a diagnosis, to indicate the clinical feature in which they made the diagnosis, and to select a treatment they would recommend for treating the case. The results indicated that most therapists can distinguish a PMS case from a non-PMS case based on the cyclical versus noncyclical feature. The number of psychotherapists who misdiagnosed the case, however, is seen as cause for concern.     

Semantic aphasia: A neglected entity

Three cases of semantic aphasia are reported. Computerized brain tomography showed bilateral temporo-parieto-occipital junction hemorrhages in one patient, and left parieto-occipital junction infarctions in the other two patients. The auditory comprehension defect of the three patients was characterized by preserved understanding of single words and impaired understanding of grammatically complex constructions. It is suggested that this comprehension defect reflects an inability to fully grasp the meaning of words and grammatical constructions imbued with spatial or quasi-spatial significance. Each of the three patients showed a complex spatial disorder that included constructional apraxia, spatial agnosia, and elements of Gerstmann's syndrome. The aphasic as well as the spatial disorder of semantic aphasics may be manifestations of a common defect in the perception of spatial relationships produced by left temporo-parieto-occipital region damage.     

Teenage depression: a cultural-interpersonal-intrapsychic perspective

The "crossroads families" are caught between old value systems and American mainstream goals. Traditional family and sex-related roles and orientations conflict with those of the new social system. In turn, neither of the teenager's orientations--toward home or toward peer activity--is validated. In the clinical case presented, Anna, at adolescence, wants to relinquish many of her household chores and enter her social world more fully. She needs unconflictual support for such a move. If this does not take place, her autonomous movement represents an unconscious betrayal of her depleted and controlling mother as well as an abandonment of the parental coalition. This leaves her feeling resentful, guilty, and ultimately unlovable. Attitudes marked by helplessness and confusion are thus significant to the depressed affect that brings this teenager into family therapy. Teenagers of non-Hispanic background who enter family therapy reveal gross overlap with teenagers of the Hispanic "crossroads" family model. Here, the family gives mixed messages for homebound and intimate closeness as well as accomplishment in the societal mainstream. A primary difference between ethnic groups involves the freer expressions of anger and pain between husband and wife in the non-Hispanic families. This is not similar to the backgrounds of the more individuated Hispanic teenagers. While more open expressions of anger within the family do indicate higher levels of autonomy, the hostility that is expressed by the parents presents serious complications when this includes "triangulating" the child into the family tension. Here, as cited, the mother often uses her daughter as a confidant and ally at times of severe parental discord. This places additional strain on the child's conflict with separation. Importantly, the daughter experiences renewed rejection and betrayal when the mother "submits" to her spouse. These are significant family processes that heighten mixed messages around autonomy. Milagros, a depressed (more individuated) adolescent, is consistently entangled into her parent's abrasive relationship. Her interpersonal family struggles have become intrapsychic and, ultimately, transferential.     

Common and distinct patterns of affective response in dimensions of anxiety and depression

The authors examined the time course of affective responding associated with different affective dimensions--anxious apprehension, anxious arousal, and anhedonic depression--using an emotion-modulated startle paradigm. Participants high on 1 of these 3 dimensions and nonsymptomatic control participants viewed a series of affective pictures with acoustic startle probes presented before, during, and after the stimuli. All groups exhibited startle potentiation during unpleasant pictures and in anticipation of both pleasant and unpleasant pictures. Compared with control participants, symptomatic participants exhibited sustained potentiation following the offset of unpleasant stimuli and a lack of blink attenuation during and following pleasant stimuli. Common and unique patterns of affective responses in the 3 types of mood symptoms are discussed.     

Premenstrual Syndrome and Misattribution: A Self-Perception,Individual Differences Perspective

Self-perception theory suggests that premenstrual syndrome (PMS) may arise from the misattribution of hormone-induced bodily changes. If so, individual differences in the role of bodily responses in emotional feelings, measured in a separate expression-manipulation procedure, should be related to susceptibility to PMS. In Study 1, women responsive to cues from their bodies showed significant mood changes, both negative and positive, with their cycle, over a 60 day span; whereas women relatively unresponsive to personal, bodily cues showed no consistent cycle effects. PMS was also predicted by a measure of emotional complexity. In Study 2 women whose moods were based on bodily cues also rated their moods as less positive if they were in their premenstrual week, and women unresponsive to their bodies were unaffected by their cycle. A reminder of their cycle-stage prevented PMS in the body cue group, which is a kind of discounting effect. Women who were unresponsive to their bodies also did not show PMS, and were unaffected by the reminder.     

Psychological treatment of depression: a review

The available empirical evidence on the efficacy of psychological intervention in depressive disorders is reviewed. No fully adequate study has yet appeared; but there seems sufficient consensus to justify the conclusion that psychological treatment can be effective in alleviating current depressive states and that more complex therapies involving both behavioural and cognitive elements appear the most promising. However, it remains to be seen whether the success of these techniques depends upon the type of depressive disorder manifested; and whether they are applicable across a full range of verbal reasoning ability and socio-economic class.     

Premenstrual syndrome as scientific and cultural artifact

Premenstrual Syndrome (PMS) has been defined in a variety of scientific and cultural ways over the years, but there is no consistent or agreed upon definition. For some women, the public legitimization of PMS and its symptoms as a real and natural part of the female body have led to a positive sense of vindication. However, a more negative image of PMS as something that controls women once a month, that makes them “crazy” and subject to their hormones, is much more pervasive in our contemporary Western culture. In this essay, the author explores the various definitions: PMS as a medical condition, as a social scientific and feminist issue, as an explanation for women's behavior and moods in the popular culture, and, finally, as something bought or sold in a market. The author shows how PMS is real because, if for no other reason, various people in different situations choose to define it as such. Reprinted from Figert, Anne E.Women and the Ownership of PMS: The Structuring of a Psychiatric Disorder. Aldine Transaction.     

Premenstrual Syndrome as Scientific and Cultural Artifact

Premenstrual Syndrome (PMS) has been defined in a variety of scientific and cultural ways over the years, but there is no consistent or agreed upon definition. For some women, the public legitimization of PMS and its symptoms as a real and natural part of the female body have led to a positive sense of vindication. However, a more negative image of PMS as something that controls women once a month, that makes them "crazy" and subject to their hormones, is much more pervasive in our contemporary Western culture. In this essay, the author explores the various definitions: PMS as a medical condition, as a social scientific and feminist issue, as an explanation for women's behavior and moods in the popular culture, and, finally, as something bought or sold in a market. The author shows how PMS is real because, if for no other reason, various people in different situations choose to define it as such.     

Premenstrual Syndrome: The Role of Emotion Regulation Strategies and Trait Meta-Mood

Journal of Rational-Emotive & Cognitive-Behavior Therapy - The aim of the current study was to compare women with premenstrual syndrome (PMS) and with women in a non-PMS group with regard to...     

Cognitive vulnerability to depression: a taxometric analysis

Although there is increasing support for the hypothesis that negative cognitive styles contribute vulnerability to depression, it remains unclear how best to conceptualize the heterogeneity in cognitive vulnerability to depression. Specifically, does this heterogeneity reflect quantitative or qualitative differences among individuals? The goal of this study was to address this question by examining whether the underlying structure of cognitive vulnerability to depression is best conceptualized as dimensional or categorical. Taxometric analyses provided consistent support for the dimensional nature of negative cognitive styles. It appears, therefore, that cognitive vulnerability to depression is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Despite this, the strength of the relationship between negative cognitive styles and depressive symptoms does appear to vary as a function of where along the cognitive style continuum one falls.     

Premenstrual Symptoms in Young Japanese Women: Agency, Communion and Lifestyle Habits

This study aimed to examine associations between the traits of agency and communion and the severity of premenstrual symptoms in young Japanese women, considering lifestyle habits. The participants were 512 Japanese female undergraduate students in the Kansai area (mean age?=?18.5?years, SD?=?.9). The participants were assigned a self-administered questionnaire. Multiple regression analyses showed that higher levels in unmitigated agency were positively associated with total scores of premenstrual symptoms, as well as subscales of concentration, behavioral change, water retention, negative affect and arousal. Higher levels in communion were also positively associated with water retention. However, these associations were attenuated when lifestyle habits were taken into account, except for communion, which remained positively associated with water retention. A psychological approach for gender-related traits could be effective in treating premenstrual symptoms.     

Attributional style in depression: a meta-analytic review

In this article we report meta-analyses of the relation of attributional styles to depression. In 104 studies involving nearly 15,000 subjects, several attributional patterns had reliable associations with depression scores. For negative events, attributions to internal, stable, and global causes had a reliable and significant association with depression. Studies in which the attribution factors of ability and luck were measured also showed a reliable association with depression. For positive events, attributions to external, unstable, and specific causes were associated with depression. Ability and luck attribution factors for positive events were also associated with depression. The relations for positive events, however, were weaker than the corresponding ones for negative events. In general, these patterns of relations were independent of a number of potential mediators suggested by authors in this literature, including the type of subject studied (psychiatric vs. college student), the type of event about which the attribution is made (real vs. simulated), the depression measure used, or the publication status of the research report. These conclusions are compared with those of other reviews. Implications for attributional models of depression are discussed.