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The DSM-V published in 5/2013 with PMDD being an official diagnosis, thus I deleted content about criticism of PMDD being labeled as psychiatric disorder and not a "physical disorder."
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==Diagnosis==
==Diagnosis==
Originally called '''late luteal phase dysphoric disorder''' (LLPDD), the disorder was renamed PMDD by the [[American Psychiatric Association]] in its May 1993 revision of the [[DSM-IV]]. It was not recognized as a disorder in the DSM-IV, but was noted in the appendix of the manual as a "disorder requiring further study."<ref>{{cite news| author=Laurence, Leslie | title=Psychiatric group scruitinzes categorizing form of PMS | publisher=Chicago Tribune | date=1993-05-16 }}</ref><ref>{{cite news| author=Lehman, Betsy | title=A little revision is creating a big furor |publisher=Boston Globe| date=1993-05-10}}</ref> The [[DSM-5]], due for release in 2013, recognizes PMDD and gives precise and sophisticated guidelines for diagnosis.<ref>D 04 Premenstrual Dysphoric Disorder
Originally called '''late luteal phase dysphoric disorder''' (LLPDD), the disorder was renamed PMDD by the [[American Psychiatric Association]] in its May 1993 revision of the [[DSM-IV]]. It was not recognized as a disorder in the DSM-IV, but was noted in appendix B, "Criteria Sets and Axes Provided for Further Study."<ref>{{cite news| author=Laurence, Leslie | title=Psychiatric group scruitinzes categorizing form of PMS | publisher=Chicago Tribune | date=1993-05-16 }}</ref><ref>{{cite news| author=Lehman, Betsy | title=A little revision is creating a big furor |publisher=Boston Globe| date=1993-05-10}}</ref> In the May 2013 publication of the DSM-V, premenstrual dysphoric disorder has been moved from Appendix B to the main body of DSM-V.<ref>http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf</ref>

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=484</ref> The DSM-5 draft resembles the expert guidelines<ref name="Steiner"/> for the treatment of severe PMS, PMDD, and comorbidities proposed by Steiner and co-authors.


PMDD is accepted as an illness by the [[Food and Drug Administration]] (FDA) but has not as yet been listed as a separate disorder in the [[World Health Organization]]'s [[ICD|International Classification of Diseases (ICD-10)]]. Listing may be imminent, however, since the current alpha draft of ICD-11 extends recognition,<ref>[http://apps.who.int/classifications/icd11/browse/f/en#/http%3A%2F%2Fwho.int%2Ficd%232772_712a6f06_71f2_48d0_919c_2b3cb8b7172d ICD11 Beta Premenstrual Dysphoric Disorder (PMDD) retrieved Oct. 17, 2012]</ref> albeit in a way lacking the clinical sophistication of the [[DSM-5]] approach.
PMDD is accepted as an illness by the [[Food and Drug Administration]] (FDA) but has not as yet been listed as a separate disorder in the [[World Health Organization]]'s [[ICD|International Classification of Diseases (ICD-10)]]. Listing may be imminent, however, since the current alpha draft of ICD-11 extends recognition,<ref>[http://apps.who.int/classifications/icd11/browse/f/en#/http%3A%2F%2Fwho.int%2Ficd%232772_712a6f06_71f2_48d0_919c_2b3cb8b7172d ICD11 Beta Premenstrual Dysphoric Disorder (PMDD) retrieved Oct. 17, 2012]</ref> albeit in a way lacking the clinical sophistication of the [[DSM-5]] approach.
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<blockquote> ...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.<ref>{{cite web| url=http://www.emea.eu.int/pdfs/human/referral/326303en.pdf | title=Summary Information...for Prozac and associated names| author=European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products| date=2003-06-13}}</ref></blockquote>
<blockquote> ...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.<ref>{{cite web| url=http://www.emea.eu.int/pdfs/human/referral/326303en.pdf | title=Summary Information...for Prozac and associated names| author=European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products| date=2003-06-13}}</ref></blockquote>


In Australia, although PMDD is recognized by the [[Therapeutic Goods Administration]], SSRIs are not reimbursed for it under the [[Pharmaceutical Benefits Scheme]].<ref>[http://www.npsradar.org.au/site.php?page=1&content=/npsradar/content/sertraline.html Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD)] National Prescribing Service Limited. (Australia)</ref>
In Australia, although PMDD is recognized by the [[Therapeutic Goods Administration]], SSRIs are not reimbursed for it under the [[Pharmaceutical Benefits Scheme]].<ref>[http://www.npsradar.org.au/site.php?page=1&content=/npsradar/content/sertraline.html Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD)] National Prescribing Service Limited. (Australia)</ref>Treatment

Some commentators suggest that PMDD (along with [[heart disease]], [[borderline high blood pressure]], mild [[hypercholesterolemia]], [[social anxiety disorder]], [[restless leg syndrome]], and [[female sexual dysfunction]]) has been marketed by pharmaceutical companies in order to increase the demand for treatments.<ref name="pmid16597181">{{cite journal
|author=Mintzes B
|title=Disease mongering in drug promotion: do governments have a regulatory role?
|journal=PLoS Med.
|volume=3
|issue=4
|pages=e198
|year=2006
|month=April
|pmid=16597181
|pmc=1434509
|doi=10.1371/journal.pmed.0030198 }}</ref> Some psychiatrists and women's groups{{who|date=June 2013}} say that labeling this severe form of PMS as a psychiatric disorder, rather than a physical disorder, is stigmatizing. Psychologist [[Peggy Kleinplatz]] has criticized the diagnosis as part of a trend in [[medicalization]] of normal human behavior.<ref name="offman2004">Offman A, Kleinplatz PJ (2004). Does PMDD Belong in the DSM? Challenging the Medicalization of Women's Bodies. ''The Canadian Journal of Human Sexuality'', Vol. 13</ref>


== Treatment ==
==Treatment==
The primary goal of treatment is to reduce the patient's suffering and the disruption to their social relationships.
The primary goal of treatment is to reduce the patient's suffering and the disruption to their social relationships.


Revision as of 17:37, 28 June 2013

Premenstrual dysphoric disorder
SpecialtyGynaecology Edit this on Wikidata

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome,[3] afflicting 3% to 8% of women.[4] It is a diagnosis associated primarily with the luteal phase of the menstrual cycle. Up to one-third of women diagnosed with PMDD report residual symptoms into the first 2 or 3 days of the follicular phase.[5]

Symptoms

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.[6]

Emotional symptoms are generally present, and in PMDD, mood symptoms are dominant.[6] Substantial disruption to personal relationships is typical for women with PMDD.[6] Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include[7]

  • feelings of deep sadness or despair
  • feelings of intense tension or anxiety
  • increased intense sensitivity to rejection or criticism
  • panic attacks
  • rapid and severe mood swings, bouts of uncontrollable crying
  • lasting irritability or anger, increased interpersonal conflicts; typically sufferers are unaware of the impact they have on those close to them
  • apathy or disinterest in daily activities and relationships
  • difficulty concentrating
  • chronic fatigue
  • food cravings or binge eating
  • insomnia or hypersomnia; sleeping more than usual, or (in a smaller group of sufferers) being unable to sleep
  • feeling overwhelmed or feelings of being out of control
  • increase or decrease in sex drive
  • increased need for emotional closeness

Common physical symptoms include:

  • breast tenderness or swelling, heart palpitations, headaches, joint or muscle pain, swollen face and nose
  • an altered view of one's body - a sensation of 'bloating', feeling fat or actual weight gain.
  • severe headache

Five or more of these symptoms may indicate PMDD.

Cause

In 2007, the first significant genetic finding in premenstrual dysphoric disorder was reported.[8][9] Variants in the estrogen receptor alpha gene are associated with PMDD. Women with these genetic variants were more likely to suffer from PMDD. They also discovered that this association is seen only in women with a variant form of another gene, Catechol-O-methyl transferase also known as COMT, which is involved in regulating the function of the prefrontal cortex, a critical regulator of mood.

Previously, research showed that women with PMDD have an abnormal response to normal hormone levels, and, thus, are differentially sensitive to their own natural hormone changes.

There is objective correlational evidence of a neurological connection for PMDD distress. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be significantly correlated with the concomitant worsening of their brain serotonin precursors, measured by positron emission tomography (PET).[10]

While the cause of PMDD has not been definitively established, a leading theory suggests it is due to the lack of serotonin (a neurotransmitter) and mediated by the fluctuations of the levels of sex hormones (progesterone, estrogen, and testosterone) in the luteal phase of the menstrual cycle.[10]

Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been shown[6] in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase, as detailed in the treatment section below.

Women with PMDD who have never experienced major depressive disorder (MDD) have lower sensitivity and response to stress and pain than people with a MDD.[11] This suggests that PMDD is a separate disease from MDD.

Unipolar depression, anxiety disorders, and other Axis I disorders are more common in women with premenstrual dysphoric disorder (PMDD) than in women without PMDD.[12]

General life stress is also associated with the prevalence of PMDD and the severity of symptoms. [13] Research shows that perceived discrimination is a stressor associated with the lifetime prevalence of PMDD. [14] The experience of subtle forms of gender and race discrimination is correlated with PMDD among ethnic minority women. [15]

Diagnosis

Originally called late luteal phase dysphoric disorder (LLPDD), the disorder was renamed PMDD by the American Psychiatric Association in its May 1993 revision of the DSM-IV. It was not recognized as a disorder in the DSM-IV, but was noted in appendix B, "Criteria Sets and Axes Provided for Further Study."[16][17] In the May 2013 publication of the DSM-V, premenstrual dysphoric disorder has been moved from Appendix B to the main body of DSM-V.[18]

PMDD is accepted as an illness by the Food and Drug Administration (FDA) but has not as yet been listed as a separate disorder in the World Health Organization's International Classification of Diseases (ICD-10). Listing may be imminent, however, since the current alpha draft of ICD-11 extends recognition,[19] albeit in a way lacking the clinical sophistication of the DSM-5 approach.

In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for fluoxetine sold in Europe.[20] Reflecting the approach of the ICD-10, the committee found that

...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.[21]

In Australia, although PMDD is recognized by the Therapeutic Goods Administration, SSRIs are not reimbursed for it under the Pharmaceutical Benefits Scheme.[22]Treatment

Treatment

The primary goal of treatment is to reduce the patient's suffering and the disruption to their social relationships.

Selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy.[23] Several randomized, placebo-controlled trials in women with PMDD have clearly demonstrated that the SSRIs have excellent efficacy and minimal side effects.[24][25] The U.S. Food and Drug Administration (FDA) has approved four SSRIs for the treatment of PMDD: Fluoxetine (available as generic or as Prozac or Sarafem), sertraline (Zoloft), paroxetine (Paxil) and escitalopram oxalate (Lexapro).

Hormonal birth control such as drospirenone/ethinyl estradiol (YAZ, Yasmin, Beyaz, etc.) can also dramatically improve symptoms for most women, although for some can worsen symptoms.

Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose.[26] There is some evidence that vitamin B6 can alleviate symptoms.[27]

See also

References

  1. ^ Halbreich U (2004). "The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder--clinical procedures and research perspectives". Gynecol. Endocrinol. 19 (6): 320–34. doi:10.1080/0951590400018215. PMID 15724807. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. ^ Endicott J, McLaughlin TP, Grudzinski AN (2003). "Comparison of managed care charges among patients treated with selective serotonin reuptake inhibitors for premenstrual dysphoric disorder". J Clin Psychiatry. 64 (12): 1511–6. doi:10.4088/JCP.v64n1216. PMID 14728114. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  3. ^ "Premenstrual dysphoric disorder (PMDD) is the severe form of PMS." http://patients.uptodate.com/topic.asp?file=endocrin/10662
  4. ^ PMDD affects "... 3-8% of women of reproductive age. Assessment of published reports demonstrate that the prevalence of clinically relevant dysphoric premenstrual disorder is probably higher. 13-18% of women of reproductive age may have premenstrual dysphoric symptoms severe enough to induce impairment and distress, though the number of symptoms may not meet the arbitrary count of 5 symptoms on the PMDD list." PMID 12892987
  5. ^ Yonkers KA, Pearlstein T, Fayyad R, Gillespie JA. Luteal phase treatment of premenstrual dysphoric disorder improves symptoms that continue into the postmenstrual phase. J Affect Disord. 2005 Apr;85(3):317-21. doi:10.1016/j.jad.2004.10.006 PMID 15780701
  6. ^ a b c d Steiner M, Pearlstein T, Cohen LS; et al. (2006). "Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs". J Womens Health (Larchmt). 15 (1): 57–69. doi:10.1089/jwh.2006.15.57. PMID 16417420. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  7. ^ Premenstrual Syndrome: "What is Premenstrual Dysphoric Disorder (PMDD?)"
  8. ^ Huo L, Straub RE, Roca C, Schmidt PJ, Shi K, Vakkalanka R, Weinberger DR, Rubinow DR (2007). "Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor alpha gene". Biol. Psychiatry. 62 (8): 925–33. doi:10.1016/j.biopsych.2006.12.019. PMC 2762203. PMID 17599809. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  9. ^ "UNC Center for Women's Mood Disorders" http://www.med.unc.edu/psych/wmd/research/pmdd
  10. ^ a b Eriksson O, Wall A, Marteinsdottir I; et al. (2006). "Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria". Psychiatry Res. 146 (2): 107–16. doi:10.1016/j.pscychresns.2005.02.012. PMID 16515859. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Klatzkin RR, Lindgren ME, Forneris CA, Girdler SS (2010). "Histories of major depression and premenstrual dysphoric disorder: Evidence for phenotypic differences". Biol Psychol. 84 (2): 235–47. doi:10.1016/j.biopsycho.2010.01.018. PMC 2877489. PMID 20138113. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Kim DR, Gyulai L, Freeman EW, Morrison MF, Baldassano C, Dubé B (2004). "Premenstrual dysphoric disorder and psychiatric co-morbidity". Arch Womens Ment Health. 7 (1): 37–47. doi:10.1007/s00737-003-0027-3. PMID 14963731. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. ^ Pilver, C, Desai, R, Kasl, S & Levy, B, 2011, ‘Lifetime Discrimination Associated with Greater Likelihood of Premenstrual Dysphoric Disorder’, Journal of Women’s Health, vol. 20, no. 6, pp. 923-931.
  14. ^ Pilver, C, Desai, R, Kasl, S & Levy, B, 2011, ‘Lifetime Discrimination Associated with Greater Likelihood of Premenstrual Dysphoric Disorder’, Journal of Women’s Health, vol. 20, no. 6, pp. 923-931.
  15. ^ Pilver, C, Desai, R, Kasl, S & Levy, B, 2011, ‘Lifetime Discrimination Associated with Greater Likelihood of Premenstrual Dysphoric Disorder’, Journal of Women’s Health, vol. 20, no. 6, pp. 923-931.
  16. ^ Laurence, Leslie (1993-05-16). "Psychiatric group scruitinzes categorizing form of PMS". Chicago Tribune.
  17. ^ Lehman, Betsy (1993-05-10). "A little revision is creating a big furor". Boston Globe.
  18. ^ http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
  19. ^ ICD11 Beta Premenstrual Dysphoric Disorder (PMDD) retrieved Oct. 17, 2012
  20. ^ Ray Moynihan (2004-02-14). "Controversial disease dropped from Prozac product information". BMJ. 328 (7436): 7436. doi:10.1136/bmj.328.7436.365. PMC 341379. PMID 14962861.
  21. ^ European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products (2003-06-13). "Summary Information...for Prozac and associated names" (PDF).
  22. ^ Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)
  23. ^ Steiner M, Pearlstein T, Cohen LS; et al. (2006). "Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs". J Womens Health (Larchmt). 15 (1): 57–69. doi:10.1089/jwh.2006.15.57. PMID 16417420. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  24. ^ Steiner M, Pearlstein T (2000). "Premenstrual dysphoria and the serotonin system: pathophysiology and treatment". J Clin Psychiatry. 61 Suppl 12: 17–21. PMID 11041380.
  25. ^ Premenstrual Syndrome
  26. ^ Steinberg S, Annable L, Young SN, Liyanage N (1999). "A placebo-controlled study of the effects of L-tryptophan in patients with premenstrual dysphoria". Adv. Exp. Med. Biol. Advances in Experimental Medicine and Biology. 467: 85–8. doi:10.1007/978-1-4615-4709-9_11. ISBN 978-0-306-46204-7. PMID 10721042.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. ^ http://altmed.creighton.edu/pmdd/b6.htm



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