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

Kaynakça

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