Progesterone,fluid, and electrolytes in premenstrual syndrome.

Changes in mood, plasma progesterone concentration, urinary volume, sodium excretion, sodium:potassium ratio, and body weight during the menstrual cycle were determined in 18 women with premenstrual syndrome and 10 symptomless (control group) women. Plasma progesterone concentration was higher in the women with symptoms during the postovulatory phase of the cycle, and the peak progesterone concentration appeared earlier. The changes in progesterone concentration were accompanied by a natriuresis and diuresis that fell towards preovulatory values in the premenstrual phase. Sodium retention was not confined to any definite period. Mood symptoms occurred after the changes in progesterone and electrolyte concentrations. Progesterone deficiency is probably not the cause of premenstrual syndrome. Thus treatment with progesterone is probably illogical unless a deficiency is detected. Treatment should be aimed at preventing the natriuretic effect of progesterone in the postovulatory phase and the sodium-retaining and water-retaining effects of aldosterone in the premenstrual phase.     

Changes in social dynamics associated to the menstrual cycle in the vervet monkey (Cercopithecus aethiops)

Behavioral changes associated to the menstrual cycle in a social group of vervet monkeys (Cercopithecus aethiops) were studied. Three adult females were used as experimental subjects and in these, vaginal smears were taken every other day in order to detect their menstrual cycles. Only the dominant and the mid-ranking female showed regular cycles while the low-ranking female showed amenorrhea. The menstrual cycles were divided into five periods (menstrual, premenstrual, luteal, ovulatory and follicular) which were related to the behavioral data. Social behavior recordings were taken during one hour daily for five consecutive months; the data were adjusted twice in order to follow the cycles of the females with regular menstruations. By plotting in a matrix the relative frequencies of joins and displacements, the social position of each animal as well as the group's social organization and dynamics were evaluated. A clear tendency towards social rejection (emitting less joins and increasing the amount of displacements) was detected during the premenstrual periods of the dominant female which abruptly changed towards affiliation during menstruation. This observation was detected in all group members no matter their age-sex class or social position during the five months of observation. When the data were analyzed following the mid-ranking female's cycle, no consistent changes were apparent. The importance of social stimuli in the modulation and expression of hormone-related behavior is stressed, as well as the need of using social settings in the experimental analyses of premenstrual mood and behavior disorders.     

Mood and the Menstrual Cycle: A Review of Prospective Data Studies

BackgroundThe human menstrual cycle (MC) has historically been the focus of myth and misinformation, leading to ideas that constrain women's activities.ObjectivesWe wished to examine one pervasive idea, that the MC is a cause of negative mood, by studying the scientific literature as a whole. We briefly reviewed the history of the idea of premenstrual syndrome and undertook a systematic review of quality studies.MethodsWe searched PubMed, PsycINFO, and article bibliographies for published studies using non-help–seeking samples with daily mood data collected prospectively for a minimum of 1 complete MC. We critiqued their methodologies and tabulated the key findings.ResultsOf 47 English language studies identified, 18 (38.3%) found no association of mood with any MC phase; 18 found an association of negative mood in the premenstrual phase combined with another MC phase; and only 7 (14.9%) found an association of negative mood and the premenstrual phase. Finally, the remaining 4 studies (8.5%) showed an association between negative mood and a non-premenstrual phase. Considering the only 41 adequately powered studies, the same phase links were reported by 36.6%, 41.5%, and 13.5% of studies, respectively. Their diversity of methods (sampling, instruments, and cycle phase definitions) precluded a meta-analysis.ConclusionsTaken together, these studies failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome in the general population. This puzzlingly widespread belief needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality.     

Pilot Investigation of the Circadian Plasma Melatonin Rhythm across the Menstrual Cycle in a Small Group of Women with Premenstrual Dysphoric Disorder

Women with premenstrual dysphoric disorder (PMDD) experience mood deterioration and altered circadian rhythms during the luteal phase (LP) of their menstrual cycles. Disturbed circadian rhythms may be involved in the development of clinical mood states, though this relationship is not fully characterized in PMDD. We therefore conducted an extensive chronobiological characterization of the melatonin rhythm in a small group of PMDD women and female controls. In this pilot study, participants included five women with PMDD and five age-matched controls with no evidence of menstrual-related mood disorders. Participants underwent two 24-hour laboratory visits, during the follicular phase (FP) and LP of the menstrual cycle, consisting of intensive physiological monitoring under “unmasked”, time-isolation conditions. Measures included visual analogue scale for mood, ovarian hormones, and 24-hour plasma melatonin. Mood significantly (P≤.03) worsened during LP in PMDD compared to FP and controls. Progesterone was significantly (P = .025) increased during LP compared to FP, with no between-group differences. Compared to controls, PMDD women had significantly (P<.05) decreased melatonin at circadian phases spanning the biological night during both menstrual phases and reduced amplitude of its circadian rhythm during LP. PMDD women also had reduced area under the curve of melatonin during LP compared to FP. PMDD women showed affected circadian melatonin rhythms, with reduced nocturnal secretion and amplitude during the symptomatic phase compared to controls. Despite our small sample size, these pilot findings support a role for disturbed circadian rhythms in affective disorders. Possible associations with disrupted serotonergic transmission are proposed.     

Reproductive depression

Reproductive depression is the depression in women that is related to the hormonal changes of the menstrual cycle, pregnancy and the menopause and is manifested clinically as premenstrual depression, postnatal depression and climacteric depression. These three components occur in the same vulnerable women in that a woman with depression in the menopausal transition will usually have a history of premenstrual syndrome (PMS; premenstrual dysphoric disorder [PMDD]), would have been in a good mood during pregnancy and then develop postnatal depression. When the periods return the depression becomes cyclical as PMS. These three conditions are effectively treated with transdermal estrogens which should be the first-choice therapy rather than antidepressants. Estrogens can be used together with antidepressants. The critical time to prevent long-term mood problems is the correct treatment of postnatal depression. In women with low energy and libido, often a side effect of antidepressants, the addition of transdermal testosterone is useful. These women with reproductive depression are often progesterone/progestogen intolerant and a smaller dose or duration of progestogen is a necessary compromise. Alternatively a Mirena IUS or rarely a hysterectomy is required.     

Perimenstrual behavior changes among female yellow baboons: Some similarities to premenstrual syndrome (PMS) in women

Although numerous studies have documented changes in the behavior of nonhuman primate females around the time of ovulation, very little attention has been paid to behavior changes around the time of menstruation. Yet such information is obviously relevant to under standing the origins and etiology of the adverse mood and behavior changes experienced premenstrually by many women. Analysis of data obtained during 115 hours of observation on 13 female Amboseli (Kenya) baboons (Papio cynocephalus) during 24 menstrual periods showed that prior to and during the time of menstrual onset, these individuals exhibited distinct changes in their activity budgets, nearest-neighbor distances, and patterns of social interaction. Furthermore, in comparison to females around the time of ovulation, perimenstrual females showed increased rates of agonistic interaction and decreased (but nonzero) rates of sexual interaction with adult males. These premenstrual and perimenstrual behavior changes among female yellow baboons thus show some intriguing similarities to several commonly reported behavioral symptoms of premenstrual syndrome (PMS) in women.     

Changes in mood, cognitive performance and appetite in the late luteal and follicular phases of the menstrual cycle in women with and without PMDD (premenstrual dysphoric disorder)

Although it's been reported that women with premenstrual dysphoric disorder (PMDD) have increased negative mood, appetite (food cravings and food intake), alcohol intake and cognitive deficits premenstrually, few studies have examined these changes concurrently within the same group of women or compared to women without PMDD. Thus, to date, there is not a clear understanding of the full range of PMDD symptoms. The present study concurrently assessed mood and performance tasks in 29 normally cycling women (14 women who met DSM-IV criteria for PMDD and 15 women without PMDD). Women had a total of ten sessions: two practice sessions, 4 sessions during the follicular phase and 4 sessions during the late luteal phase of the menstrual cycle. Each session, participants completed mood and food-related questionnaires, a motor coordination task, performed various cognitive tasks and ate lunch. There was a significant increase in dysphoric mood during the luteal phase in women with PMDD compared to their follicular phase and compared to Control women. Further, during the luteal phase, women with PMDD showed impaired performance on the Immediate and Delayed Word Recall Task, the Immediate and Delayed Digit Recall Task and the Digit Symbol Substitution Test compared to Control women. Women with PMDD, but not Control women, also showed increased desire for food items high in fat during the luteal phase compared to the follicular phase and correspondingly, women with PMDD consumed more calories during the luteal phase (mostly derived from fat) compared to the follicular phase. In summary, women with PMDD experience dysphoric mood, a greater desire and actual intake of certain foods and show impaired cognitive performance during the luteal phase. An altered serotonergic system in women with PMDD may be the underlying mechanism for the observed symptoms; correspondingly, treatment with specific serotonin reuptake inhibitors (SSRIs) remains the preferred treatment at this time.     

Changes in Total Body Water and Body Fat in Young Women in the Course of Menstrual Cycle

This paper reports on the changes in total body water and body fat in young women in during the course of the menstrual cycle. We followed 40 young women with an average age of 21.52 years, and took bioelectrical impedance measurements during two menstrual cycles. The measurements were taken in three phases of the menstrual cycle. We found that body mass and total body water fluctuate during the menstrual cycle. Both parameters are highest in the luteal phase and lowest in the late folicular phase; 65% of the young women demonstrated these changes. The presence or absence of premenstrual symptoms had no influence on these values.     

Psychiatric Morbidity and Referral on Two General Medical Wards

Psychiatric morbidity among 230 medical inpatients was determined by a two-stage screening procedure, using the General Health Questionnaire and Standardized Psychiatric Interview. Of these patients, 23% were considered psychiatrically ill, affective disorders being the commonest illnesses encountered; and 27 (12%) were psychiatrically referred. While referral was related to severity of psychiatric illness and previous psychiatric illness, the degree to which the psychiatric illness obtruded or created problems in management appeared more crucial in determining referral. In half of those with psychiatric illness the problems did not appear to have been detected or dealt with. It is suggested that medical clerking should routinely include questions about mood and psychological responses to illness.     

Behavioral changes across the menstrual cycle in isosexual groups of bonnet macaques (Macaca radiata)

Behavioral changes were systematically recorded across menstrual cycles over a six-month period in two laboratory-housed isosexual triads ofMacaca radiata (bonnet macaque). The purpose of this study was to determine whether females of this species demonstrate premenstrual behavioral changes as reported for humans, or heightened levels of aggression during the first half of their cycle as reported in some species of Old World monkeys. A total of 34 menstrual cycles were divided into five segments including two follicular, one periovulatory, and two luteal phases. The mean frequencies of behaviors were analyzed according to phase, rank, and time since triad formation, for a total of 34 menstrual cycles. There was no evidence of an increase in spatial separation during the premenstrual phase or during any other phase of the menstrual cycle. Although contact aggression did not show an increase during the early follicular half of the cycle (phases 1 and 2) or during the phase of the cycle immediately preceding menses (phase 5), contact aggression did show two peaks: one in the early-mid luteal half of the cycle (phase 4) and a peak in the mid-late follicular (phase 2). The non-aggressive hierarchical behaviors did not follow the same pattern as contact aggression. Instead the distribution of these behaviors showed a pattern similar to that of estrogen levels across the cycle. Subjects’ location in pen also varied significantly according to cycle phase: subjects spent more time on perches during the premenstrual phase and more time on the pen floor during the periovulatory phase. The increase in contact aggressive behaviors during the early-mid follicular phase and the mid-late luteal phase does not suggest a simple hormonal correlate as these two phases are characterized by high levels of estrogen and progesterone, respectively. However, the distribution of non-aggressive hierarchical behaviors suggest that this category of agonistic interaction may be related to mating competition among females of this species. Results are discussed with reference to the social behavior and promiscuous mating strategy ofM. radiata. The findings in this present study are compared with previous studies utilizing other species of Old World monkeys. Differences in study design and group composition are considered as factors effecting discrepant results both within and between species.     

Analysis of TBX1 variation in patients with psychotic and affective disorders

A significant portion of patients with 22q11 deletion syndrome (22q11DS) develop psychiatric disorders, including schizophrenia and other psychotic and affective symptoms, and the responsible gene/s are assumed to also play a significant role in the etiology of nonsyndromic psychiatric disease. The most common psychiatric diagnosis among patients with 22q11DS is schizophrenia, thought to result from neurotransmitter imbalances and also from disturbed brain development. Several genes in the 22q11 region with known or suspected roles in neurotransmitter metabolism have been analyzed in patients with isolated schizophrenia; however, their contribution to the disease remains controversial. Haploinsufficiency of the TBX1 gene has been shown to be sufficient to cause the core physical malformations associated with 22q11DS in mice and humans and via abnormal brain development could contribute to 22q11DS-related and isolated psychiatric disease. 22q11DS populations also have increased rates of psychiatric conditions other than schizophrenia, including mood disorders. We therefore analyzed variations at the TBX1 locus in a cohort of 446 white patients with psychiatric disorders relevant to 22q11DS and 436 ethnically matched controls. The main diagnoses included schizophrenia (n = 226), schizoaffective disorder (n = 67), bipolar disorder (n = 82), and major depressive disorder (n = 29). We genotyped nine tag SNPs in this sample but did not observe significant differences in allele or haplotype frequencies in any of the analyzed groups (all affected, schizophrenia and schizoaffective disorder, schizophrenia alone, and bipolar disorder and major depressive disorder) compared with the control group. Based on these results we conclude that TBX1 variation does not make a strong contribution to the genetic etiology of nonsyndromic forms of psychiatric disorders commonly seen in patients with 22q11DS.     

The dreams of women with and without severe emotional behavioral premenstrual symptoms.

Women with severe premenstrual symptoms, who tend to have more mood changes during the late luteal phase of their cycle than do women with few or no symptoms, often complain of having unpleasant dreams. This study examined whether these women experienced more intense negative dream emotions during the late luteal phase of their cycle compared with women with minimal symptoms. It also examined whether there was a relationship between presleep mood and dream affect. Seventeen women participated in the study (9 with severe symptoms, 8 with minimal symptoms). Analyses of variance revealed an increase in negative dream affect and misfortunes during the late luteal phase (p     

Psychiatric morbidity in patients with alcoholic liver disease.

Seventy one patients with alcoholic liver disease and an equal number with non-alcoholic liver disease were interviewed using the schedule for affective disorders and schizophrenia. Forty seven (66%) of the group with alcoholic liver disease had or had had psychiatric illnesses compared with 23 (32%) of the control group (p less than 0.001). Affective disorder, particularly major depression, neurotic disorders, and antisocial personality, were all more common among the patients with alcoholic liver disease than the controls. No patient had schizophrenia or other forms of psychosis. Among the patients with alcoholic liver disease 11 men (24%) and 14 women (54%) had an affective or a neurotic disorder that had antedated their heavy drinking, and 30 (77%) of those who had had such a problem at any time had symptoms at the time of interview. Abstinence from alcohol is essential for patients with severe alcoholic liver disease. In view of the high prevalence of psychiatric disorders in these patients psychiatric assessment is important to increase the patients'' likelihood of complying with such advice.     

Aportaciones de los tests de supresión de cortisol al conocimiento de los trastornos psiquiátricos: revisión narrativa de la literatura

Activity of the hypothalamic-pituitary-adrenal axis had been studied for the past half century, when some researchers noted that some patients with Cushing's syndrome and severe mood disorders had high baseline cortisol levels, which resulted in an inhibited response in the 1 mg dexamethasone suppression test. Altered dexamethasone suppression test results were subsequently found in many psychiatric diseases, including anorexia nervosa, obsessive-compulsive disorder, degenerative dementia, bipolar disorders, and schizophrenia. The relationship between high baseline cortisol levels and stress has also been studied. Some researches on the genesis of borderline personality disorder focused on traumatic childhood backgrounds. Other investigations aimed at elucidating the relationship between traumatic backgrounds and some psychiatric disorders noted that patients with post-traumatic stress disorder and borderline personality disorder showed an enhanced cortisol suppression with low cortisol doses (0.5 mg). Recent studies showed that use of an ultra-low dose of cortisol during the dexamethasone suppression test may be helpful for deteting disorders with hyperactivity of the hypothalamic-pituitary-adrenal axis.Recent advances in neuroimaging support the existence of hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with borderline personality disorder, relating a decreased pituitary gland volume to major traumatic backgrounds and suicidal attempts. The purpose of this paper is to make a narrative review of research using dexamethasone suppression test in psychiatric disorders, in order to ascertain its value as a supplemental diagnostic test or as a prognostic marker.     

The resting frontal alpha asymmetry across the menstrual cycle: a magnetoencephalographic study

Gonadotropic hormones play an important role in the regulation of emotion. Previous studies have demonstrated that estrogen can modulate appetitive (approach/positive) and aversive (avoidance/negative) affective behaviors during the menstrual cycle. Frontal alpha asymmetry (a measure of relative difference of the alpha power between the two anterior hemispheres) has been associated with the trait and state reactivity of different affective styles. We studied the pattern change of frontal alpha asymmetry across the menstrual cycle. 16 healthy women participated in this resting magneto-encephalographic (MEG) study during the peri-ovulatory (OV) and menstrual (MC) phases. Our results showed significant interaction of resting MEG alpha activity between hemispheric side and menstrual phases. Difference in spontaneous frontal alpha asymmetry pattern across the menstrual cycle was also noted. Relatively higher right frontal activity was found during the OV phase; relatively higher left frontal activity was noted during the MC phase. The alteration of frontal alpha asymmetry might serve a sub-clinical correlate for hormonal modulation effect on dynamic brain organization for the predisposition and conceptualization of different affective styles across the menstrual cycle.     

The Compensatory Immune-Regulatory Reflex System (CIRS) in Depression and Bipolar Disorder

Here, we review a novel concept namely the compensatory immune-regulatory reflex system (CIRS) as applied to the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). There is evidence that a substantial subset of individuals with MDD and BD exhibit an activation of the immune-inflammatory response system (IRS), as indicated by an increased production of macrophagic M1 and T helper (Th)-1 pro-inflammatory cytokines, interleukin (IL)-6 trans-signaling, positive acute phase proteins (APPs), and complement factors. These immune aberrations appear to be evident during the course of major affective episodes of either depressive or (hypo) manic polarity. Here, we review (a) the current state of the art of CIRS functions in both mood disorders and (b) the possible role of CIRS-related biomarkers for the understanding of affective disorders within the framework of precision psychiatry that could also provide novel drug targets for both MDD and BD. CIRS-related abnormalities in mood disorders include elevated Th-2 and T regulatory (Treg) activities with increased IL-4 and IL-10 production, classical IL-6 signaling, increased levels of sIL-1R antagonist (sIL-1RA), soluble IL-2 (sIL-2R) and tumor necrosis factor–α- receptors, and positive APPs, including haptoglobin, hemopexin, α1-acid glycoprotein, α1-antitrypsin, and ceruloplasmin. It is concluded that CIRS is involved in MDD and BD by regulating the primary immune-inflammatory response, thereby contributing to spontaneous and antidepressant-promoted recovery from the acute phase of illness. Signs of activated IRS and CIRS pathways are observed in the remitted phases of both disorders indicating that there is no return to the original homeostasis after an acute episode, while later episodes of mood disorders are characterized by sensitized IRS and CIRS responses. New z-unit weighted composite biomarker scores are proposed, which reflect different aspects of IRS versus CIRS activation and may be used to estimate different IRS/CIRS activity ratios in mood and other neuroimmune disorders.     

Disturbances of affective cognition in mood disorders

正Mood disorders, also known as affective disorders, result in a consistent disturbance in mood. There are two major subtypes of mood disorders, i.e., major depressive disorder(MDD) and bipolar disorder (BD). Mood disorders affect hundreds of millions of people and are the most common mental disorders. According to China’s national survey in2009 (Phillips et al., 2009), the weighted 12-month prevalence of mental disorders was 17.5%and 9.3%, respectively. Mood disorders were among the highest prevalence rate disorders related to disease’s increased burdens.     

Progesterone and the premenstrual syndrome: a double blind crossover trial.

A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos''s menstrual distress questionnaire, Beck et al''s depression inventory, Spielberger et al''s state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.     

Sex, stress, and mood disorders: at the intersection of adrenal and gonadal hormones

The risk for neuropsychiatric illnesses has a strong sex bias, and for major depressive disorder (MDD), females show a more than 2-fold greater risk compared to males. Such mood disorders are commonly associated with a dysregulation of the hypothalamo-pituitary-adrenal (HPA) axis. Thus, sex differences in the incidence of MDD may be related with the levels of gonadal steroid hormone in adulthood or during early development as well as with the sex differences in HPA axis function. In rodents, organizational and activational effects of gonadal steroid hormones have been described for the regulation of HPA axis function and, if consistent with humans, this may underlie the increased risk of mood disorders in women. Other developmental factors, such as prenatal stress and prenatal overexposure to glucocorticoids can also impact behaviors and neuroendocrine responses to stress in adulthood and these effects are also reported to occur with sex differences. Similarly, in humans, the clinical benefits of antidepressants are associated with the normalization of the dysregulated HPA axis, and genetic polymorphisms have been found in some genes involved in controlling the stress response. This review examines some potential factors contributing to the sex difference in the risk of affective disorders with a focus on adrenal and gonadal hormones as potential modulators. Genetic and environmental factors that contribute to individual risk for affective disorders are also described. Ultimately, future treatment strategies for depression should consider all of these biological elements in their design.     

The Effects of Menstrual Cycle on Dreaming

In this study we have investigated the effect that the menstrual cycle has on dreams, sleep quality and mood. A total of 16 women, university students, with a regular menstrual cycle of 28 days, not on any form of hormonal treatment were tested over five weeks. Methods of diary of dreams, daily self-evaluation of mood and weekly self-assessment of quality of sleep were adopted. Mood scores varied significantly during the menstrual cycle (p &lt; 0.05) with improvement of mood around the time of ovulation and worsening during the pre-menstrual phase of the cycle. Sleep quality did not vary significantly during the menstrual cycle. During the pre-ovulatory phase of the cycle dreams had the highest levels of incongruity (p &lt; 0.05), number of positive emotions (p &lt; 0.0005), number of male-non-self-characters (p &lt; 0.005) and erotic content (p &lt; 0.001). While during the pre-menstrual phase dreams were longer (p &lt; 0.05) and with a larger number of female characters (p &lt; 0.005) and of negative emotions (p &lt; 0.0005). These results suggest that the hormonal variations during the menstrual cycle may have an effect on dreaming. Both the preovulatory oestrogen peak and the presence of progesterone during the luteal phase may enhance memory processes involved in the dream production.