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Prämenstruelle dysphorische Störung

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Vorlage:Infobox disease

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome,[1] afflicting 3% to 8% of women.[2] It is a diagnosis associated primarily with the luteal phase of the menstrual cycle. Up to one-third of women diagnosed with PMDD report residual symptoms into the first 2 or 3 days of the follicular phase.[3]

Symptoms

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.[4]

Emotional symptoms are generally present, and in PMDD, mood symptoms are dominant.[4] Substantial disruption to personal relationships is typical for women with PMDD.[4] Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include[5]

  • feelings of deep sadness or despair, and suicide ideation
  • feelings of intense tension or anxiety
  • increased intense sensitivity to rejection or criticism
  • panic attacks
  • rapid and severe mood swings, bouts of uncontrollable crying
  • lasting irritability or anger, increased interpersonal conflicts; typically sufferers are unaware of the impact they have on those close to them
  • apathy or disinterest in daily activities and relationships
  • difficulty concentrating
  • chronic fatigue
  • food cravings or binge eating
  • insomnia or hypersomnia; sleeping more than usual, or (in a smaller group of sufferers) being unable to sleep
  • feeling overwhelmed or feelings of being out of control
  • increase or decrease in sex drive
  • increased need for emotional closeness

Common physical symptoms include:

  • breast tenderness or swelling, heart palpitations, headaches, joint or muscle pain, swollen face and nose
  • an altered view of one's body - a sensation of 'bloating', feeling fat or actual weight gain.

Five or more of these symptoms may indicate PMDD.

Cause

In 2007, the first significant genetic finding in premenstrual dysphoric disorder was reported.[6][7] Variants in the estrogen receptor alpha gene that are associated with PMDD. Women with these genetic variants were more likely to suffer from PMDD. They also discovered that this association is seen only in women with a variant form of another gene, Catechol-O-methyl transferase also known as COMT, which is involved in regulating the function of the prefrontal cortex, a critical regulator of mood.

Previously, research showed that women with PMDD have an abnormal response to normal hormone levels, and, thus, are differentially sensitive to their own natural hormone changes.

There is objective correlational evidence of a neurological connection for PMDD distress. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be significantly correlated with the concomitant worsening of their brain serotonin precursors, measured by positron emission tomography (PET).[8]

While the cause of PMDD has not been definitively established, a leading theory suggests it is due to the lack of serotonin (a neurotransmitter) and mediated by the fluctuations of the levels of sex hormones (progesterone, estrogen, and testosterone) in the luteal phase of the menstrual cycle.[8]

Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been shown[4] in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase, as detailed in the treatment section below.

Women with PMDD who have never experienced major depressive disorder (MDD) have lower sensitivity and response to stress and pain than people with a MDD.[9] This suggests that PMDD is a separate disease from MDD.

Unipolar depression, anxiety disorders, and other Axis I disorders are more common in women with premenstrual dysphoric disorder (PMDD) than in women without PMDD.[10]

Diagnosis

Originally called late luteal phase dysphoric disorder (LLPDD), the disorder was renamed PMDD by the American Psychiatric Association in its May 1993 revision of the DSM-IV. It was not recognized as a disorder in the DSM-IV, but was noted in the appendix of the manual as a "disorder requiring further study."[11][12] The DSM-5, due for release in 2013, recognizes PMDD and gives precise and sophisticated guidelines for diagnosis.[13] The DSM-5 draft resembles the expert guidelines[4] for the treatment of severe PMS, PMDD, and comorbidities proposed by Steiner and co-authors.

PMDD is accepted as an illness by the Food and Drug Administration (FDA) but has not as yet been listed as a separate disorder in the World Health Organization's International Classification of Diseases (ICD-10). Listing may be imminent, however, since the current alpha draft of ICD-11 extends recognition,[14] albeit in a way lacking the clinical sophistication of the DSM-5 approach.

In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for fluoxetine sold in Europe.[15] Reflecting the approach of the ICD-10, the committee found that

...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.[16]

In Australia, although PMDD is recognized by the Therapeutic Goods Administration, SSRIs are not reimbursed for it under the Pharmaceutical Benefits Scheme.[17]

Some commentators suggest that PMDD (along with heart disease, borderline high blood pressure, mild hypercholesterolemia, social anxiety disorder, restless leg syndrome, and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments.[18] Some psychiatrists and women's groups say that labeling this severe form of PMS as a psychiatric disorder, rather than a physical disorder, is stigmatizing. Psychologist Peggy Kleinplatz has criticized the diagnosis as part of a trend in medicalization of normal human behavior.[19]

Treatment

The primary goal of treatment is to reduce the patient's suffering and the disruption to her social relationships.

Selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy.[20] Several randomized, placebo-controlled trials in women with PMDD have clearly demonstrated that the SRIs have excellent efficacy and minimal side effects.[21][22] The U.S. Food and Drug Administration (FDA) has approved four SSRIs for the treatment of PMDD: Fluoxetine (available as generic or as Prozac or Sarafem), sertraline (Zoloft), paroxetine (Paxil) and escitalopram oxalate (Lexapro).

Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose.[23] There is some evidence that vitamin B6 can alleviate symptoms.[24]

See also

References

Vorlage:Reflist

Vorlage:Menstrual cycle

  1. ↑ "Premenstrual dysphoric disorder (PMDD) is the severe form of PMS." http://patients.uptodate.com/topic.asp?file=endocrin/10662
  2. ↑ PMDD affects "... 3-8% of women of reproductive age. Assessment of published reports demonstrate that the prevalence of clinically relevant dysphoric premenstrual disorder is probably higher. 13-18% of women of reproductive age may have premenstrual dysphoric symptoms severe enough to induce impairment and distress, though the number of symptoms may not meet the arbitrary count of 5 symptoms on the PMDD list." PMID 12892987
  3. ↑ Yonkers KA, Pearlstein T, Fayyad R, Gillespie JA. Luteal phase treatment of premenstrual dysphoric disorder improves symptoms that continue into the postmenstrual phase. J Affect Disord. 2005 Apr;85(3):317-21. doi:10.1016/j.jad.2004.10.006 PMID 15780701
  4. ↑ a b c d e Steiner M, Pearlstein T, Cohen LS, et al.: Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs. In: J Womens Health (Larchmt). 15. Jahrgang, Nr. 1, 2006, S. 57–69, doi:10.1089/jwh.2006.15.57, PMID 16417420 (liebertonline.com).
  5. ↑ Premenstrual Syndrome: "What is Premenstrual Dysphoric Disorder (PMDD?)"
  6. ↑ Huo L, Straub RE, Roca C, Schmidt PJ, Shi K, Vakkalanka R, Weinberger DR, Rubinow DR: Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor alpha gene. In: Biol. Psychiatry. 62. Jahrgang, Nr. 8, Oktober 2007, S. 925–33, doi:10.1016/j.biopsych.2006.12.019, PMID 17599809, PMC 2762203 (freier Volltext) – (elsevier.com).
  7. ↑ "UNC Center for Women's Mood Disorders" http://www.med.unc.edu/psych/wmd/research/pmdd
  8. ↑ a b Eriksson O, Wall A, Marteinsdottir I, et al.: Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria. In: Psychiatry Res. 146. Jahrgang, Nr. 2, März 2006, S. 107–16, doi:10.1016/j.pscychresns.2005.02.012, PMID 16515859.
  9. ↑ Klatzkin RR, Lindgren ME, Forneris CA, Girdler SS: Histories of major depression and premenstrual dysphoric disorder: Evidence for phenotypic differences. In: Biol Psychol. 84. Jahrgang, Nr. 2, Mai 2010, S. 235–47, doi:10.1016/j.biopsycho.2010.01.018, PMID 20138113, PMC 2877489 (freier Volltext).
  10. ↑ Kim DR, Gyulai L, Freeman EW, Morrison MF, Baldassano C, Dubé B: Premenstrual dysphoric disorder and psychiatric co-morbidity. In: Arch Womens Ment Health. 7. Jahrgang, Nr. 1, Februar 2004, S. 37–47, doi:10.1007/s00737-003-0027-3, PMID 14963731.
  11. ↑ Laurence, Leslie: Psychiatric group scruitinzes categorizing form of PMS, Chicago Tribune, 16. Mai 1993 
  12. ↑ Lehman, Betsy: A little revision is creating a big furor, Boston Globe, 10. Mai 1993 
  13. ↑ D 04 Premenstrual Dysphoric Disorder http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=484
  14. ↑ [http://apps.who.int/classifications/icd11/browse/f/en#/http%3A%2F%2Fwho.int%2Ficd%232772_712a6f06_71f2_48d0_919c_2b3cb8b7172d ICD11 Beta Premenstrual Dysphoric Disorder (PMDD) retrieved Oct. 17, 2012]
  15. ↑ Ray Moynihan: Controversial disease dropped from Prozac product information. In: BMJ. 328. Jahrgang, Nr. 7436, 14. Februar 2004, S. 7436, doi:10.1136/bmj.328.7436.365, PMID 14962861, PMC 341379 (freier Volltext).
  16. ↑ European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products: Summary Information...for Prozac and associated names. 13. Juni 2003;.
  17. ↑ Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)
  18. ↑ Mintzes B: Disease mongering in drug promotion: do governments have a regulatory role? In: PLoS Med. 3. Jahrgang, Nr. 4, April 2006, S. e198, doi:10.1371/journal.pmed.0030198, PMID 16597181, PMC 1434509 (freier Volltext).
  19. ↑ Offman A, Kleinplatz PJ (2004). Does PMDD Belong in the DSM? Challenging the Medicalization of Women's Bodies. The Canadian Journal of Human Sexuality, Vol. 13
  20. ↑ Steiner M, Pearlstein T, Cohen LS, et al.: Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs. In: J Womens Health (Larchmt). 15. Jahrgang, Nr. 1, 2006, S. 57–69, doi:10.1089/jwh.2006.15.57, PMID 16417420.
  21. ↑ Steiner M, Pearlstein T: Premenstrual dysphoria and the serotonin system: pathophysiology and treatment. In: J Clin Psychiatry. 61 Suppl 12. Jahrgang, 2000, S. 17–21, PMID 11041380.
  22. ↑ Premenstrual Syndrome
  23. ↑ Steinberg S, Annable L, Young SN, Liyanage N: A placebo-controlled study of the effects of L-tryptophan in patients with premenstrual dysphoria. In: Adv. Exp. Med. Biol. 467. Jahrgang, 1999, S. 85–8, PMID 10721042.
  24. ↑ http://altmed.creighton.edu/pmdd/b6.htm
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