A Diagnosis with Little Awareness in Adolescence: Menstrual Psychosis

Abstract

Menstrual psychosis has been described as a brief psychotic episode acute in its onset, rapid in its resolution, and marked by variable temporal boundaries within the menstrual cycle. It is a rare disorder with a crudely estimated prevalence of 1 in 10,000. To confirm a case with menstrual psychosis clinically, detailed dates regarding the association of the menstrual cycle and psychosis are necessary. Menstrual psychosis occurs most commonly in phases of the menstrual cycle where estrogen levels are low. It is thought to be caused by increased dopamine sensitivity during the low estrogen phases of the menstrual cycle. The mainstay of pharmacological treatment in menstrual psychosis is neuroleptics, mood stabilizers, and hormonal therapy. Antipsychotics and antidepressants have been reported to be helpful during acute psychotic states in menstrual psychoses, but have not been documented as successful monotherapy in the prevention of further episodes in the treatment of menstrual psychoses. Severe affective instability with evident psychosis during the menstrual cycle should be evaluated for menstrual psychosis. Further research is needed to describe most aspects of the disorder, including prevalence, pathophysiology, genetic risk, and evidence-based therapies. Menstrual psychosis is a distinct category of mental illness that should be managed by a multidisciplinary team. Education on menstrual psychosis should also be increased as it is likely to be missed clinically. Increased identification is important as the treatment is effective, and safe.

Keywords

• Adolescent
• Menstruation
• Psychosis

Ergenlik Döneminde Farkındalığı Az Olan Bir Tanı: Menstruel Psikoz

Öz

Menstrüel psikoz, akut başlayan, hızlı çözülen ve adet döngüsü içinde değişken zamansal sınırlarla karakterize kısa bir psikotik epizod olarak tanımlanmıştır. Kabaca tahmin edilen prevalansı 10.000'de 1 olan nadir bir hastalıktır. Menstrüel psikozlu bir vakayı klinik olarak doğrulamak için menstrüel siklus ve psikoz ilişkisine ilişkin ayrıntılı tarihler gereklidir. Menstrüel psikoz, en sık östrojen seviyelerinin düşük olduğu adet dönemlerinde ortaya çıkar. Adet döngüsünün düşük östrojen fazları sırasında artan dopamin duyarlılığından kaynaklandığına düşünülmektedir. Menstrüel psikozda farmakolojik tedavinin temeli nöroleptikler, duygudurum düzenleyiciler ve hormon tedavisidir. Antipsikotikler ve antidepresanların, menstrüel psikozdaki akut durumlarda yardımcı olduğu bildirilmiş, ancak bu ilaçların gelecek atakların önlenmesinde monoterapi olarak faydalı olduğu belgelenmemiştir. Menstrüel psikoz tanısı için şiddetli afektif dengesizlik belirgin psikozla birlikte adet döngüsü sırasında değerlendirilmelidir. Prevalans, patofizyoloji, genetik risk ve kanıta dayalı tedaviler dahil olmak üzere bozukluğun birçok yönünü tanımlamak için daha fazla araştırmaya ihtiyaç vardır. Menstrüel psikoz, multidisipliner bir ekip tarafından yönetilmesi gereken ayrı bir ruhsal hastalık kategorisidir. Klinik olarak gözden kaçırılması muhtemel olduğundan, menstrüel psikoz eğitimi de artırılmalıdır. Gelişen tanımlamalar tedavinin etkili ve güvenli olabilmesi için önemlidir.

Anahtar Kelimeler

• Adölesan
• Menstrüasyon
• Psikoz

References

1. Ahern E, Cohen D, Prior C, Raji E (2019) Menstruel Psychosis. Ir J Psychol Med, 10:1-3.
2. Aktepe E, Özen E, Eroğlu FÖ (2016) Menstruel Psychosis. Anadolu Psikiyatri Derg, 17:88-90.
3. Al-Sibani N, Al-Maqbali M, Mahadevan S, Al-Huseini S, Al-Muzeni M (2020) Psychiatric, cognitive functioning and socio-cultural views of menstrual psychosis in Oman: an idiographic approach. BMC Womens Health, 20:215.
4. Ambelas A, Kat H (1998) Periodic menstruation linked psychosis of adolescence. Int J Psychiatry Clin Pract, 2:61-63.
5. Arteaga TL, Lopez ML (2013) Cyclic psychosis and menstruation: presentation of a case. Rev Psiquiatr Salud Ment, 6:52-53.
6. Beckmann D, Lowman KL, Nargiso J, McKowen J, watt L, Yule AM (2020) Substance-induced Psychosis in Youth. Child Adolesc Psychiatr Clin N Am, 29:131-143.
7. Bergemann B, Parzer P, Runnebaum B, Resch F (2007) Estrogen, menstrual cycle phases and psychopathology in women suffering from schizophrenia. Psychol Med, 37:1427-1436.
8. Brockington I (1998) Menstruel psychosis. Arch Womens Ment Health, 1: 3-13.

9. Brockington IF (2011) Menstrual Psychosis: A bipolar disorder with a link to the hypothalamus. Curr Psychiatry Rep, 13:193–197.
10. Che KI (2016) Recurrent psychotic episodes with a near-monthly cycle. East Asian Arch Psychiatry, 26:137-140.
11. Clifford J, Rowland J (2011) The potential role of oestrogens in relapse of recurrent affective psychosis. JRSM Short Rep, 2:82.
12. Colak S, Suyabatmaz G, Hocaoglu C (2020) A little known topic ‘Menstrual Psychosis’: A case report and a short review literature. The Journal of Gynecology - Obstetrics and Neonatology, 17:629-631.
13. Deuchar N, Brockington I (1998) Puerperal and menstrual psychoses: The proposal of a unitary etiological hypothesis. J Psychosom Obstet Gynaecol, 19:104-110.
14. Ellison-Wright Z, O’Keane V (2013) Menstrual psychosis in an adolescent girl. Prog Neurol Psychiatry Case Notes, 17-23.
15. Fatica JP, Jiwani S, Salman R, Majeed S (2018) Premenstrual psychosis in an adolescent: a case report. Clin Schizophr Relat Psychoses, Available from: URL: https://doi.org/10.3371/CSRP.FAJI.061518. Accessed date: 1.10.2021.
16. Fernando MD, Grizaffi J, Crapanzano A, Jones GN (2014) Catamenial psychosis in an adolescent girl. BMJ Case Rep, Available from: URL: https://casereports.bmj.com/content/2014/bcr-2014-206589. Accessed date: 1.10.2021.
17. Fiorentini A, Volonteri LS, Dragogna F, Rovera C, Maffini M, Mauri MC et al. (2011) Substance-induced psychoses: a critical review of the literature. Curr Drug Abuse Rev, 4:228-240.
18. Grünewald BD, Korte A, Schulte-Körne G (2012) Psychotic episodes during menstruation in a 12-year-old girl: a case of menstrual psychosis. Eur Child Adolesc Psychiatry, 21:173-175.
19. Heinzman JT, Buckingham ET (2019) Menstrual psychosis and the workup of new-onset psychosis in a teenager. J Am Acad Child Adolesc Psychiatry Connect, 6(2):36-39.
20. Karatepe HT, Işık H, Sayar K, Yavuz F (2010) Menstruation-Related Recurrent Psychotic Disorder: a case report. Dusunen Adam, 23:282-287.
21. Kiel W, Rhonda W, Geetanjali R (2018) A case of menstrual psychosis, an under recognized diagnosis. Online J Neurol Brain Disord, 2:109-111.
22. Kobayashi T, Kato S (2009) Menstruel Catatonia. Psychiatry Clin Neurosci, 63:772-774.
23. Langer S, Frankel J, Derish N, Paulsen R, Coffey BJ (2019) Brief psychosis in the premenstrual phase in an adolescent girl: Adolescent menstrual psychosis?. J Child Adolesc Psychopharmacol, 5:392-394.
24. Metin Ö, Sevince O, Tahiroğlu A, Avcı A, Çelik G (2016) Menstrual psychosis in an adolescent girl. 8th International Congress on Psychopharmacology 4th International Symposium on Child and Adolescent Psychopharmacology, 20 - 24 Nisan 2016 Antalya, Türkiye. Klinik Psikofarmakol Bülteni 26(suppl 1):S494.
25. Özdel K, Kervancıoğlu A, Taymur İ, Efe C, Türkçapar AF, Güriz SO et al. (2015) Premenstrual Symptom Screening Tool: A Useful Tool for DSM-5 Premenstrual Dysphoric Disorder. Journal of Clinical And Analytical Medicine, 6(5): 581-585.
26. Öztürk K, Yücel G, Çaksen H (2019) Menstruation Related Recurrent Psychosis: A case report. Pediatric Practice and Research, 7(suppl):191-194.
27. Pfuhlmann B, Jabs B, Althaus G, Schmidtke A, Bartsch A, Stöber G et al. (2004) Cycloid psychoses are not part of a bipolar affective spectrum: results of a controlled family study. J Affect Disord, 83:11-19.
28. Ray R, Paul I (2020) Menstruel psychosis: A not so forgotten reality. Indian J Psychiatry, 62:585-587. Reilly TJ, De la Bastida VCS, Joyce DW, Cullen AE, McGuire P (2020) Exacerbation of psychosis during the perimenstrual phase of the menstrual cycle: Systematic review and meta-analysis. Schizophr Bull (Bp), 46: 78-90.
29. Santos-Cubina J, Castaing-Lespier PA, Sabate N, Torres-Martin A, Quinones-Fernandini VM (2013) Menstrual psychosis: presenting symptom of bipolar disorder not otherwise specified in a 13-years-old Hispanic female. Bol Asoc Med P R, 105:53- 55.
30. Stein D, Blumensohn R, Witztum (2003) Perimenstrual Psychosis among Female Adolescents: Two Case Reports and an Update of the Literature. Int J Psychiatry Med, 33:169-179.
31. Takahashi Y, Mikami K, Akama F, Onishi Y, Yamamoto K, Matsumoto H et al. (2020) Reconsideration of periodic psychosis of adolescence. Tokai J Exp Clin Med, 45:1-4.
32. Thippaiah SM, Nagaraja S, Birur B, Cohen AW (2018) An interesting presentation about cyclical menstrual psychosis with an updated review of literature. Psychopharmacol Bull, 48:16-21.
33. Türkçapar AF, Türkçapar MH (2011) Diagnosis and Treatment of Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Review. Klinik Psikiyatri Dergisi, 14:241-253.
34. Ward HB, Greenberg JA, Almedia M (2020) Perimenstruel psychiatric hospitalization: case report. Arch Womens Ment Health, 23:141-147.
35. Wieck A, Davies R, Hirst A, Brown N, Papadopoulos A, Marks M et al. (2003) Menstrual cycle effects on hypothalamic dopamine receptor function in women with a history of puerperal bipolar disorder. J Psychopharmacol 17:204-209.