1649 – Possible menstrual psychosis: a case report

Abstract

IntroductionDescribed since the 19th century, menstrual psychosis is considered a forgotten disorder. Current classification systems do not include the diagnosis of menstrual psychosis, a condition comprising in psychotic episodes recurring during each menstrual or premenstrual period, but remitting the rest of the month. The world literature consists mainly of case reports. To our knowledge this is the first Romanian report of menstrual psychosis.ObjectivesTo describe the course of the condition in a patient with multiple and rapid recurring psychotic episodes from onset until the most recent hospitalization.AimsTo better understand if this case could be considered a true menstrual psychosis.MethodsReview of the medical charts of the 57 hospitalizations the patient has had between 1977 and 2012 in the “Prof. Dr. Al. Obregia” Psychiatry Hospital.ResultsInitial diagnosis included discordant psychosis and atypical depressive state that shifted in time to schizoaffective disorder and various forms of schizophrenia. The history reveals cyclic episodes with short-term remissions and multiple hospitalizations. Treatment approaches also varied during the course of the disease, from ECT to second generation of antipsychotics without any consistent long-term remission. The frequency of episodes started to dramatically reduce only when the menopause installed.ConclusionPatients with a history of numerous admissions might benefit from a record review aimed at identifying temporal patterns. Clinicians should be aware of menstrual psychotic symptoms exacerbations in a minority of women with chronic mental disorders and therapeutic strategies need to be carefully considered and adjusted to each individual patient.