Introduction
Periodic psychosis is acknowledged as a distinct, although uncommon, condition that is marked by an abrupt onset of psychotic symptoms, lasting a brief period and fully recovering in a patient who was previously normal. The disorder also occurs in a circa-menstrual or menstrual-related manner. Premenstrual mood fluctuations and the aggravation of preexisting mental illness throughout the menstrual cycle are not considered.
Based on when it occurs during the menstrual cycle, it has been further classified as follows: premenstrual psychosis, which occurs in the second half of the cycle and resolves at the onset of menstruation; catamenial psychosis, which starts during the onset of menstrual bleeding; paramenstrual psychosis, which has a variable onset in rhythm with the cycle; mid-cycle psychosis; and epochal menstrual psychosis, which is a bipolar illness with switching associated with the menstrual cycle. Menstrual psychosis has been reported to begin at several stages of reproductive life, such as menarche, the prepubertal stage, amenorrhea, the postpartum stage, and interestingly, even beyond menopause.
What Causes Menstrual Psychosis?
Psychosis in female patients appears to be associated with a deficiency in estrogen function, and the condition is cyclically correlated with levels of estrogen. Responses to estrogen, progesterone, or their combination are not always consistent. The cyclical symptoms are greatly reduced when the menstrual cycles are suppressed.
What Are Premenstrual Disturbances?
The premenstrual phase, which precedes menstruation, is frequently associated with mental anguish. Menstrual cycle conditions include premenstrual tension syndrome, premenstrual dysphoric disorder, and the worsening of a coexisting medical condition during the premenstrual period.
Menstruation has been associated with a variety of psychopathological symptoms, including feelings of persecution, elevated anxiety, dysphoria, and low self-esteem. A person may experience feelings of loneliness and possibly even develop depression as a result of behavioral changes, such as a reduction in social involvement throughout the menstrual cycle.
It has been noted in a number of publications that menstruation tends to exacerbate psychopathological symptoms and mental problems, including addiction, suicidal thoughts and feelings, and psychoses. There is also a connection between the existence of eating disorder symptoms and variations in ovarian hormone levels. According to research, women may be more likely to commit suicide when they are menstruating. The signs and symptoms of menstruation can seriously affect mental health and have dire repercussions.
Tension Before Menstruation
Specific metabolic, environmental, or behavioral elements that emerge during the menstrual cycle's luteal phase indicate premenstrual tension syndrome. It causes recurrent physical, behavioral, or emotional symptoms that interfere with day-to-day functioning. Although research in this field varies in quality, women frequently report mood swings, melancholy, stress, irritation, and rage that manifest before menstruation.
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder is a condition distinguished by emotional, cognitive, and physical symptoms that occur consistently in the days preceding menstruation and resolve shortly after that. These physical symptoms include joint discomfort, overeating, and fatigue, whereas cognitive problems include forgetfulness and difficulty concentrating. Irritability and depression are two common mood-related symptoms.
Co-occurring Conditions
Women with schizophrenia who are admitted to psychiatric hospitals immediately before or during their menstrual cycles are more likely to have psychotic symptoms since these symptoms tend to get worse when estrogen levels fall during the premenstrual phase. Menopause's accompanying decrease in estrogen levels may be another cause of midlife women's higher risk of schizophrenia development. Premenstrual dysphoric disorder and premenstrual syndrome are common in women with bipolar disorder, particularly bipolar II disorder. Bipolar affective symptoms and mood swings may be more severe in women who have certain premenstrual illnesses.
How Long Does Menstrual Psychosis Last?
The episodes terminated two to five days following the onset of menstrual flow, at which point inter-episodic healing was totally accomplished. Only ten menstrual cycles occur annually, resulting in a lengthy intermenstrual gap.
How to Treat Menstrual Psychosis?
Psychosis in female patients appears to be associated with a deficiency in estrogen function, and the condition is cyclically correlated with levels of estrogen. Responses to estrogen, progesterone, or their combination are not always consistent. The cyclical symptoms are greatly reduced when the menstrual cycles are suppressed. Sex hormones can alter both the functional activity of brain neurotransmission and monoamine oxidase activity. It has been proposed that norepinephrine activity can be increased, and estrogen action can dampen monoamine activity. Due to its frequent correlation with anovulatory periods, it has been discovered that inducing ovulation and restoring regular menstrual cycles can help lessen symptoms in certain situations.
When treating females with anovulatory cycles, Clomiphene is beneficial. For patients who are not responding to Clomiphene citrate, Letrozole is an additional option for inducing ovulation. Menstrual psychosis has occasionally been successfully treated with Goserelin, a GnRH (gonadotropin hormone) agonist. In menstrual psychosis, neuroleptics, mood stabilizers, and hormone therapy are the mainstays of pharmacological treatment. Treatment with both Valproic acid and Risperidone resulted in symptom remission in patients who had florid psychotic symptoms and mood disorders.
Conclusion
Menstruation has a significant effect on mental health; some people have psychopathological symptoms and mood swings during their menstrual cycle. Hormonal swings and physical modifications brought on by menstruation might impact a person's emotional and mental health. In the days preceding their menstrual period, a lot of people report feeling moody, irritable, anxious, or even depressed. Premenstrual syndrome (PMS) is a common term used to describe this collection of symptoms. Premenstrual dysphoric disorder (PMDD) is a condition that affects some people who experience severe and incapacitating psychopathological symptoms related to their menstrual cycle. Severe emotional dysregulation, cognitive impairment, and physical symptoms that follow a cyclical pattern associated with the menstrual cycle are the hallmarks of PMDD. Periods might aggravate pre-existing mental health issues in addition to PMDD. Valproic acid and Risperidone showed good results in treating the symptoms; a bio-psycho-social strategy was used with the obstetrics gynecology team.
