Patients with premenstrual syndrome recorded their symptoms daily using menstrual distress questionnaires. These were analysed by a least mean square method of fitting sine waves. After recording an untreated cycle, patients were given progesterone 200 mg b.d. and placebo in a double-blind crossover manner; 75 per cent of patients were then given progesterone 400 mg b.d. and placebo in a similar manner. Treated cycles were rated by both daily menstrual distress questionnaires and retrospective self-assessment. Both rating methods showed there was no significant difference between progesterone and placebo in reducing symptoms of premenstrual syndrome, and in the majority of cases placebo was more effective, although never significantly so.

Nineteen volunteers completed a Moos Menstrual Distress Questionnaire daily for a period exceeding one menstrual cycle. The data were analysed, using a least mean square method of fitting sine waves. The fact that the results obtained on this group are essentially those found by other workers looking at the menstrual cycle suggests that this may be a useful method for assessing menstrual distress.

SYNOPSISDaily measurements of MHPG in urine have been carried out in two patients with manic-depressive psychosis. In both cases, levels in mania were elevated and in depression lowered with interval levels which were intermediate and within the normal range. The results lend some support to the suggestion that there might be an increase in brain noradrenaline metabolism in mania and a decrease in depression.

SummaryThe symptoms of premenstrual syndrome should be rated daily, or at frequent intervals throughout the menstrual cycle. Self-rating is usually most feasible and separate rating of differing symptom groups is important, as symptoms differ in their response to therapy. Daily scores should be analysed to assess periodicity, either by subdividing the cycle into phases or by using the least mean square method of fitting sine waves. Standardized scores enable data to be compared across cycles. In a clinical trial it is important to include an untreated cycle to assess whether the subject has premenstrual syndrome and as a baseline with which to compare treated cycles. Allowance should be made for a carry-over effect and for high placebo response. One solution is to use a change-over design balanced for carry-over effects. The criteria used to define a patient should be stated.

Summary1. Lithium ions in therapeutic doses cause an increase in the renal excretion of a-oxoglutarate and glutaric acid. 2. The excretion is probably due to reduced renal tubular reabsorption. 3. Neither citrate, lactate nor pyruvate excretion rises.