Factors associated with suicide risk in young women with premenstrual dysphoric disorder: A population-based study.

PURPOSE: Women with premenstrual dysphoric disorder (PMDD) are more likely to report suicide ideation and behavior when compared to women without PMDD. However, there is a lack of studies investigating the risk factors for suicide risk in women with PMDD. Thus, the aim of this study is to assess the factors associated with suicide risk in young women with PMDD. METHODS: This is a cross-sectional study including 128 young women with PMDD who were recruited from the community. PMDD and suicide risk were assessed by trained psychologists using the Mini International Neuropsychiatric Interview (MINI-PLUS). Suicide risk evaluation includes six questions that assess suicidal intention, planning and previous attempts. Subjects who answer yes to any of the six questions are classified as having current suicide risk. RESULTS: The prevalence of current suicide risk in women with PMDD was 28.1%. The factors associated with suicide risk in this population were: presenting current panic disorder (OR: 18.71 [95% CI: 1.02 - 343.27], p=0.048), a non-white skin color (OR: 4.18 [CI 95%: 1.28 - 13.61], p=0.018), greater severity of depressive symptoms (OR: 1.22 [95% CI: 1.12 - 1.32], < 0.001), and history of childhood trauma (OR: 1.04 [95% CI: 1.01 - 1.08], 0.010). CONCLUSION: Our findings indicate that there are key sociodemographic and clinical factors associated with suicide risk in young women with PMDD, enabling clinicians to identify at-risk individuals who could benefit from further screening and interventions.

Síndrome premenstrual y ejercicio físico: una revisión integrativa / Premenstrual syndrome and exercise: an integrative review

RESUMEN Introducción: El síndrome premenstrual (SPM) es una entidad clínica que afecta a un gran número de mujeres en el mundo. Este síndrome se caracteriza por la presencia de numerosos síntomas psicológicos y somáticos presentes en la fase lútea del ciclo menstrual, y según la severidad y frecuencia de los síntomas, puede afectar sus actividades en el rol familiar, social, educativo y laboral. Se han considerado numerosos abordajes desde diferentes disciplinas; en esta revisión integrativa se aborda el tratamiento desde la actividad física y el ejercicio. Se analizaron ensayos clínicos y estudios cuasiexperimentales que determinan la prevalencia del síndrome premenstrual y evalúan el efecto de la intervención con ejercicio físico en los síntomas. Metodología: Se realizó una revisión integrativa de artículos utilizando el método PRISMA, incluyendo reportes de ensayos clínicos aleatorizados y estudios cuasiexperimentales que relacionen el ejercicio con los síntomas del síndrome premenstrual. Resultados: Se analizaron 8 ensayos clínicos y 4 estudios cuasiexperimentales, en términos de población involucrada, tipo y tiempo de intervención, instrumentos de evaluación utilizados y resultados encontrados. Se concluye que el practicar diversas técnicas o disciplinas provee beneficios en términos de disminución de los síntomas tanto físicos como psicológicos, así como la combinación de actividad física con otras modalidades de tratamiento.

ABSTRACT Introduction: Premenstrual syndrome (PMS) is a clinical entity that affects many women in the world. This syndrome is characterized by the presence of numerous psychological and somatic symptoms present in the luteal phase of the menstrual cycle, depending on the severity and frequency of the symptoms, it can affect their social, educational, and work activities. Numerous approaches from different disciplines have been considered, approaching in this integrative review the treatment from physical activity and exercise. Methodology: An integrative review of articles was conducted using the PRISMA method, including reports of randomized clinical trials and quasi-experimental studies that relate exercise to premenstrual syndrome symptoms. Results: 8 clinical trials and 4 quasi-experimental studies were analyzed, in terms of population involved, type and time of intervention, evaluation instruments used, and results found. It is concluded that practicing various techniques or disciplines provide benefits in terms of reducing both physical and psychological symptoms, as well as the combination of physical activity with other treatment modalities.

Low doses of fluoxetine for the treatment of emotional premenstrual syndrome: a randomized double-blind, placebo-controlled, pilot study.

INTRODUCTION: The neuroactive metabolite of progesterone, allopregnanolone (ALLO), has been implicated in premenstrual syndrome (PMS) physiopathology and preclinical studies suggested that low doses of fluoxetine increase the ALLO brain concentration. OBJECTIVES: To assess which low dose of fluoxetine (2 mg/d, 5 mg/d or 10 mg/d), administered exclusively during the luteal phase of menstrual cycle, has a potential effect for preventing or mitigating emotional PMS symptoms. METHODS: In this randomized, double-blind, placebo-controlled pilot study, we followed 40 women (mean age = 29.7 +/- 7.4 years) with emotional PMS, during two menstrual cycles: cycle 1, without pharmacological intervention; and cycle 2, with pharmacological intervention. Participants took capsules, on average, seven days preceding the likely date of menses. We assessed the severity of PMS symptoms in both cycles using the Daily Record of Severity of Problems scale (DRSP). RESULTS: There was an increase in the DRSP scores during the late luteal phase of cycle 1, confirming the diagnosis of emotional PMS. Low doses of fluoxetine (5 mg/d: 33.5%; 10 mg/d: 48.4%) reduced DRSP total score in the day before menses (day-1) at cycle 2 compared with day-1 at cycle 1. Fluoxetine 10 mg/d had the most consistent decline in emotional PMS symptoms; 70% of the participants reported a reduction greater than 40% in the DRSP score. CONCLUSIONS: Low doses of fluoxetine, which may have no or few effect on the serotonergic system, but may interfere in the progesterone metabolization, seem to have some potential to mitigate emotional PMS symptoms. While the 10 mg/d of fluoxetine had the best performance on reducing emotional PMS symptoms, the 5 mg/d dose also seems to have some effect on emotional PMS symptoms. Further larger studies will help establish the lowest effective dose of flouxetine for PMS treatment.

Self-reported executive function, and not performance-based measures, strongly associates with symptoms of premenstrual syndrome/premenstrual dysphoric disorder / Autorreporte de funciones ejecutivas, y no medidas de desempeño, fuertemente se asocia con síntomas de síndrome premenstrual/trastorno disfórico premenstrual

Abstract Introduction Premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD) may be neuropsychologically understood as impairments of executive functions (EF), since these are related to the regulation of complex behavior and cognition. Objective To test the utility of self-report of EF versus performance-based measures, for the understanding of PMS/PMDD, and to analyze interactive effects between symptoms of these pathologies and EF on daily-life functionality. Method Mexican women were recruited through non-probabilistic procedures. The Premenstrual Symptoms Screening Tool (PSST) was used to determine severity of symptoms and functional impairment in daily-life activities, and the Behavioral Rating Inventory of Executive Functions-Adults (BRIEF-A) (short Spanish-translated version) adapted to collect information on EF during luteal versus follicular phases. Performance was evaluated with Stroop, Trail Making Test and Letter-Number Sequencing. Results A total of 157 were analyzed. Three groups were formed: No diagnosis ( n = 78); PMS ( n = 67) and PMDD ( n = 12). Between-group differences were observed for both BRIEF-A-Luteal and BRIEF-A-Follicular. Bivariate correlations between these measures and the PSST were found, with double the magnitude relative to BRIEF-A-Luteal. Only two indicators of performance-based measures were weakly associated to the PSST. The regression model showed high multicollinearity between self-reported EF and PMS/PMDD symptoms, and no interaction was found. Discussion and conclusion Self-report probed a better association than based-performance tests for the assessment of EF in PMS/PMDD. EF deficits and PMS/PMDD symptoms, particularly during luteal phase, may be as closely link as to allow for the consideration of these diagnoses as partial forms of dysexecutive syndrome.

Resumen Introducción El síndrome premenstrual/trastorno disfórico premenstrual (SPM/TDPM) pueden entenderse neuropsicológicamente como alteraciones de las funciones ejecutivas (FE), ya que éstas permiten la regulación del comportamiento complejo y la cognición. Objetivo Evaluar la utilidad del autorreporte de las FE versus pruebas de desempeño para comprender el SPM/TDPM, y analizar los efectos interactivos entre los síntomas de estas patologías y las FE sobre el funcionamiento diario. Método Mujeres mexicanas fueron reclutadas por medio de procedimientos no probabilísticos. El Instrumento de Detección de Síntomas Premenstruales (PSST) se utilizó para determinar la gravedad de los síntomas y el deterioro funcional en las actividades de la vida diaria, y el Inventario de Evaluación Conductual de la Función Ejecutiva-Adultos (BRIEF-A) (versión breve traducida al español) para recopilar información sobre EF durante las fases lútea versus folicular. Se emplearon también las pruebas de desempeño: Stroop, Trail Making Test y Secuencia de Letras y Números. Resultados Se analizó un total de 157 participantes. Se formaron tres grupos: sin diagnóstico ( n = 78); SPM ( n = 67) y TDPM ( n = 12). Se observaron diferencias entre los grupos para BRIEF-A-Lútea y BRIEF-A-Folicular. Se encontraron correlaciones bivariadas entre estas medidas y el PSST, con el doble de magnitud en relación con BRIEF-A-Lútea. Solo dos indicadores de medidas basadas en el desempeño mostraron una asociación débil con el PSST. El modelo de regresión mostró alta multicolinealidad entre el autorreporte de FE y SPM/TDPM, y no se encontró la interacción esperada. Discusión y conclusión El autorreporte mostró una mejor asociación que las pruebas de rendimiento para la evaluación de FE en SPM/TDPM. Los déficits de EF y los síntomas de SPM/TDPM, particularmente durante la fase lútea, pueden estar tan estrechamente vinculados como para permitir la consideración de estos diagnósticos como formas parciales de síndrome disejecutivo.

Fatores associados à síndrome pré-menstrual e ao transtorno disfórico pré-menstrual em estudantes da área de saúde / Factors associated with premenstrual syndrome and dysphoric disorder in health students

O estudo avaliou a frequência da síndrome pré-menstrual (SPM) e do transtorno disfórico pré-menstrual (TDPM) e fatores associados entre estudantes de cursos da área de saúde em uma universidade no Recife, Brasil. Realizou-se um corte transversal envolvendo 649 estudantes entre 18 e 47 anos, no período de setembro/2016 a março/2017. As estudantes que aceitaram participar do estudo e assinaram o termo de consentimento livre e esclarecido responderam a um questionário autoaplicável com dados sociodemográficos, hábitos de vida e antecedentes ginecológicos, bem como questões relacionadas aos critérios diagnósticos de SPM/TDPM. A maioria das estudantes tinha entre 18 e 24 anos (83,2%), era solteira (92,1%), morava com os pais (77,0%) e não trabalhava (84,4%). A frequência de SPM simples foi de 23,3% e da TDPM, de 26,7%. Os sinais e sintomas físicos foram os mais frequentes (84,1%) entre as estudantes com SPM. As 173 estudantes com TDPM relataram como sintomas mais frequentes a irritabilidade (89,6%) e a ansiedade (87,3%) acentuadas. O teste de qui-quadrado foi utilizado para comparar as proporções entre os fatores associados à SPM e ao TDPM, considerando p < 0,05. Os fatores de risco que tiveram associação estatística com a ocorrência de SPM/TDPM foram o índice de massa corporal (IMC) < 25 (p = 0,01) e irregularidade dos ciclos (p = 0,04).(AU)

This study evaluated the frequency of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) and associated factors among university students in health courses in Recife, Brazil. A cross-sectional study was carried out involving 649 students aged 18 to 47 years between September 2016 and March 2017. Students who agreed to participate in the study and signed a free informed consent form, was invited to answer a self-administered questionnaire with socio-demographic data, lifestyle and gynecological history, as well as issues related to the diagnostic criteria of PMS/PMDD. Most students were between 18 and 24 years old (83.2%), single (92.1%), living with parents (77.0%) and did not have a job (84.4%). The frequency of simple PMS was 23.3% and PMDD was 26.7%. Physical signs and symptoms were the most frequent (84.1%) among students with PMS. The 173 students with PMDD reported more frequent symptoms of irritability (89.6%) and anxiety (87.3%). The Pearson chi-square test was used to compare the proportions of the factors associated with PMS and PMDD, considering p < 0.05. BMI < 25 (p = 0.01) and cycle irregularity (p = 0.04) were the factors who had a statistically significant association with the occurrence of PMS/PMDD.(AU)

Quality of life among university students with premenstrual syndrome / Qualidade de vida entre estudantes universitárias com síndrome pré-mesntrual

Abstract Objective To evaluate the quality of life among university students with premenstrual syndrome (PMS). Methods The cross-sectional study was conducted at the Faculdade Pernambucana de Saúde, in Recife, Brazil, between August 2016 and July 2017. Sociodemographic, gynecological, and lifestyle variables, and PMS occurrence, were investigated among 642 students. The short form of the World Health Organization Quality of Life (WHOQOL Bref) questionnaire was used to evaluate four domains of the quality of life of the students: physical, mental, social relationships, and environmental. The American College of Obstetricians and Gynecologists' criteria were used to define PMS. Results Of the 642 students, 49.9% had PMS, 23.3% had mild PMS and 26.6% had premenstrual dysphoric disorder (PMDD). Most of the students were between 18 and 24 years old, had regular menstrual cycles, and practiced physical activity. Regarding the physical and mental domains of the WHOQOL-Bref questionnaire, a statisticallysignificant difference was observed between the students who did not have and those who had mild or PMDD (p < 0.001). A difference was also found between the students who did not have PMS and those who had mild PMS in the social relationships (p = 0.001) and environmental domains (p = 0.009). Conclusion Mild PMS and PMDD are prevalent among university students on healthrelated courses, and the syndrome can affect the students' self-assessment of all the domains of quality of life.

Resumo Objetivo Avaliar a qualidade de vida entre estudantes universitárias com síndrome pré-menstrual (SPM). Métodos Foi realizadoum estudo transversal na Faculdade Pernambucana de Saúde, em Recife, no período de agosto de 2016 a julho de 2017. Foram investigadas variáveis sociodemográficas, ginecológicas, estilo de vida e a ocorrência de SPM entre 642 estudantes. Foi utilizada a forma abreviada do questionário de Qualidade de Vida da Organização Mundial da Saúde (WHOQOL Bref, na sigla em inglês) para avaliar quatro domínios da qualidade de vida: físico, mental, social e meio ambiente. Para a definição de SPM, foramconsiderados os critérios do Colégio Americano de Obstetras e Ginecologistas. Resultados Das 642 estudantes, 49,9% apresentaram SPM, sendo 23,3% SPM na forma leve e 26,6%, transtorno disfórico pré-menstrual (TDPM). A maioria das estudantes tinha entre 18 e 24 anos de idade, possuia ciclosmenstruais regulares e praticava atividade física. Em relação aos domínios físico e mental do WHOQOL-Bref, observou-se diferença estatisticamente significante entre as estudantes que não apresentavam SPM e as que apresentavam SPM, tanto a forma leve quanto o TDPM (p < 0,001). Também foi encontrada diferença no domínio "relações sociais" e "meio ambiente" entre aquelas que não tiveramTPMe as que tiveramTPMleve (p = 0,001 e p = 0,009, respectivamente). Conclusão A SPM leve e o TDPM têm alta prevalencia entre estudantes universitárias da área de saúde e pode influenciar a autoavaliação das estudantes em todos os domínios da qualidade de vida.

Prevalence and factors associated with Premenstrual Dysphoric Disorder: A community sample of young adult women.

Premenstrual Dysphoric Disorder (PMDD) was recently included in DSM-5 as a full diagnostic category. Few studies have investigated PMDD in a community sample of young adults, especially in Brazil. Thus, the objective of this study was to evaluate the prevalence and the factors associated with PMDD in a community sample of 727 young adult women between the 18 and 24 years of age in southern Brazil. This was a cross-sectional population-based study. The data were collected from 2012 to 2014. PMDD was assessed using the Mini International Neuropsychiatry Interview (M.I.N.I. - Plus). The prevalence of PMDD was 17.6%. PMDD was significantly higher among older women, and in women from lower socio-economic status. A trend towards significance was found for women without a current occupation (study or work). The comorbidities significantly associated with PMDD were current major depression disorder, agoraphobia, bipolar disorder, current suicide risk, generalized anxiety disorder, social phobia, and specific phobia. The high prevalence found in the present study should be interpreted considering a retrospective report. However, our data showed that clinicians should be alert for PMDD symptoms, especially among young adult women.

Premenstrual syndrome diagnosis: A comparative study between the daily record of severity of problems (DRSP) and the premenstrual symptoms screening tool (PSST) / Diagnóstico de síndrome pré-menstrual: um estudo comparativo entre o relato diário da gravidade dos problemas (DRSP) e o instrumento de rastreamento de sintomas pré-menstruais (PSST)

Abstract Objective To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses. Methods A cross-sectional study with 127 women (20 45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values. Results Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered "normal" (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis. Conclusion The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.

Resumo Objetivo Validar o instrumento de rastreamento de sintomas pré-menstruais (PSST) em relação ao relato diário da gravidade dos problemas (DRSP) para o diagnóstico de síndrome pré-menstrual (SPM) e de transtorno disfórico pré-menstrual (TDPM). Métodos Um estudo transversal com 127 mulheres entre 20 e 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, à altura e ao índice de massa corporal (IMC). Depois de excluir o diagnóstico de depressão pelo questionário de avaliação de distúrbios mentais para atenção primária (PRIME-MD), o PSST foi respondido e as mulheres receberam orientações sobre como preencher o DRSP por dois meses. A concordância entre os dois questionários foi conduzida através do índice de Kapa (k) e pelo PABAK. Resultados Duzentos e oitenta e duas mulheres com critérios elegíveis responderam ao PSST. O DRSP foi preenchido por dois ciclos por 127 mulheres. As porcentagens de mulheres com diagnósticos de SPM e de TDPM pelo DRSP foram de 74,8% e 3,9%, respectivamente; pelo PSST, as porcentagens foram de 41,7% e 34,6%, respectivamente. O número de pacientes consideradas "normais" (com sintomas abaixo do necessário para o diagnóstico de SPM) foi similar nos dois questionários. Análises demonstraram não haver concordância entre ambos os instrumentos para os resultados diagnósticos de SPM e TDPM (Kappa = 0,12, coeficiente de PABAK = 0,39). Para o diagnóstico de SPM/TDPM, o PSST apresentou uma alta sensibilidade (79%) e baixa especificidade (33,3%). Conclusão O PSST é considerado uma ferramenta de triagem. Conclui-se que casos positivos de SPM/TDPM pelo PSST devem ser melhor investigados pelo DRSP para confirmar o diagnóstico.

Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

The objective of this study was to evaluate whether Vitex agnus castus is a safe and effective treatment for PMS and premenstrual dysphoric disorder (PMDD) and to discuss the implications of these findings for clinical practice. A systematic review of literature was conducted using PubMed and Scielo databases. The inclusion criteria were randomized controlled trials (RCT) using V. agnus castus in individuals with PMS or PMDD that compared this intervention with placebo or an active comparator and included a description of blinding and dropouts/withdrawals. The search was conducted by two independent investigators who reached consensus on the included trials. A total of eight RCTs were included in this study. Most studies focused on PMS, and the diagnostic criteria of PMS and PMDD changed over the years. Three different preparations of V. agnus castus (VAC) were tested, and there was significant variability in the measurement of treatment outcomes between the studies. Nevertheless, all eight studies were positive for VAC in the treatment of PMS or PMDD and VAC was overall well tolerated. Main limitations were differences in definition of diagnostic criteria, the instruments used as main outcome measures, and different preparations of VAC extracts limit the comparison of results between studies. In conclusion, the RCTs using VAC for treatment of PMS/PMDD suggested that the VAC extract is a safe and efficacious alternative to be considered for the treatment of PMS/PMDD symptoms.

Validation of the Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST) and association of PSST scores with health-related quality of life

Objective: To develop and validate a Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST), a questionnaire used for the screening of premenstrual syndrome (PMS) and of the most severe form of PMS, premenstrual dysphoric disorder (PMDD). The PSST also rates the impact of premenstrual symptoms on daily activities. Methods: A consecutive sample of 801 women aged ≥ 18 years completed the study protocol. The internal consistency, test-retest reliability, and content validity of the Brazilian PSST were determined. The independent association of a positive screen for PMS or PMDD and quality of life determined by the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-Bref) was also assessed. Results: Of 801 participants, 132 (16.5%) had a positive screening for PMDD. The Brazilian PSST had adequate internal consistency (Cronbach’s alpha = 0.91) and test-retest reliability. The PSST also had adequate convergent/discriminant validity, without redundancy. Content validity ratio and content validity index were 0.61 and 0.94 respectively. Finally, a positive screen for PMS/PMDD was associated with worse WHOQOL-Bref scores. Conclusions: These findings suggest that PSST is a reliable and valid instrument to screen for PMS/PMDD in Brazilian women.

Toxoplasma gondii Infection and Premenstrual Dysphoric Disorder: A Cross-Sectional Study.

BACKGROUND: Premenstrual dysphoric disorder is a severe form of premenstrual syndrome. The influence of Toxoplasma gondii (T. gondii) infection on clinical features in women with this disorder has not been studied. Therefore, we determined the association of T. gondii infection with symptoms and signs in women suffering from premenstrual dysphoric disorder. METHODS: We performed a cross-sectional study of 151 women suffering from premenstrual dysphoric disorder. Anti-Toxoplasma IgG and IgM antibodies were detected in sera of the participants using enzyme-linked immunoassays (EIAs). In addition, T. gondii DNA was detected in whole blood of IgG seropositive participants using polymerase chain reaction. We obtained the clinical data of women with the aid of a questionnaire. The association of T. gondii infection with clinical characteristics of women was assessed by bivariate and multivariate analyses. RESULTS: Anti-T. gondii IgG antibodies were found in 10 (6.6%) of the 151 women studied. Of the 10 IgG seropositive women, four (40.0%) were positive for anti-T. gondii IgM antibodies, and one (10.0%) for T. gondii DNA. Mean number (25.8 ± 7.58) of premenstrual clinical characteristics in seropositive women was similar to that (29.22 ± 9.13) found in seronegative women (P = 0.25). Logistic regression showed that seropositivity to T. gondii was negatively associated with difficulty concentrating (OR: 0.18; 95% CI: 0.03 - 0.91; P = 0.03), and positively associated with out of control feeling or overwhelmed (OR: 9.00; 95% CI: 1.32 - 62.00; P = 0.02). CONCLUSIONS: Results of this first study on the association of T. gondii infection and clinical characteristics of premenstrual dysphoric disorder suggest that this infection might be linked to some symptoms of this disorder. We report for the first time the association of T. gondii infection and out of control feeling or overwhelmed. Results warrant for further research on the role of T. gondii in premenstrual dysphoric disorder.

Validação da versão em português brasileiro da ferramenta de triagem de sintomas pré-menstruais e associação entre sintomas disfóricos pré-menstruais, temperamentos afetivos e qualidade de vida em uma amostra de mulheres brasileiras

O Transtorno Disfórico Pré-Menstrual (TDPM) afeta aproximadamente três a oito por cento das mulheres em idade fértil. Tal quadro é caracterizado por uma miríade demanifestações psicológicas (tristeza, irritabilidade, choro fácil, etc.) e físicas (dores nas articulações, inchaço, sensibilidade mamária etc.). O TDPM gera enorme sofrimento amulheres que apresentam esse quadro, acarretando disfunção no trabalho, nas relações interpessoais e prejuízo na qualidade de vida. A sintomatologia é cíclica e surge na fase lúteado ciclo menstrual, desaparecendo após o início da menstruação. Temperamentos afetivos são considerados manifestações subclínicas e precursores dos transtornos afetivos. Neste trabalho,buscou-se validar a Ferramenta de Triagem de Sintomas Pré-Menstruais (PSST), bem comoverificar se diferentes temperamentos afetivos e dimensões emocionais estariam associados a um rastreio positivo para TDPM em uma amostra de mulheres brasileiras e como a gravidaded estes sintomas poderia impactar de modo independente a qualidade de vida nesta amostra.Trata-se de um estudo quantitativo e transversal realizado em instituições universitárias do Estado do Ceará [Universidade Federal do Ceará – UFC, Centro Universitário Christus –Unichristus e Universidade de Fortaleza – UNIFOR, bem como no Hospital Universitário Walter Cantídio (HUWC), com estudantes universitárias, docentes e profissionais da saúde, totalizando uma amostra de 801 mulheres...

percent of women of childbearing age. This situation is characterized by a myriad ofpsychological (sadness, irritability, tearfulness, etc.) and physical (joint pain, bloating, breasttenderness, etc.) manifestations. PMDD generates significant distress to women leading topsychosocial dysfunction and impaired quality of life. The symptoms are cyclical and appearin the luteal phase of the menstrual cycle, disappearing after the onset of menstruation.Affective Temperaments are considered subclinical manifestations and intermediatephenotypes of affective disorders. In this work, we sought to validate the PremenstrualSymptoms Screening Tool (PSST). In addition, we aimed to verify if different affectivetemperaments and emotional dimensions could be associated with a positive screening forPMDD in a sample of Brazilian women and how the severity of premenstrual symptomscould independently impact the quality of life of this sample. This is a quantitative and crosssectionalstudy in universities of Ceará [Federal University of Ceará - UFC, University CentreChristus - Unichristus and University of Fortaleza – UNIFOR, as well as at the UniversityHospital Walter Cantídio (HUWC)], with university students, teachers and healt hprofessionals...

Síndrome premenstrual y trastorno disfórico premenstrual en la adolescencia / Premenstrual syndrome and premenstrual dysphoric disorder during adolescence

Hasta 85 por ciento de las mujeres en edad fértil presentan síntomas premenstruales. Sólo algunas de ellas cumplen criterios para Síndrome Premenstrual (SPM) y menos aún para Trastorno Disfórico Premenstrual (TDPM). Ambas patologías comienzan en la adolescencia y se asocian a consecuencias negativas que interfieren en el funcionamiento diario. A pesar de eso, pocas adolescentes consultan por estos síntomas y, cuando consultan, muchas veces, no reciben el diagnóstico ni el tratamiento adecuado. En este artículo se hace una revisión de la epidemiología, diagnóstico y tratamiento del SPM y del TDPM en adolescentes. Educación sobre cambios en estilo de vida, alimentación saludable y ejercicio, son las intervenciones más recomendadas en adolescentes. En cambio, en adultos habría mayor evidencia en tratamiento hormonal y con psicotrópicos.

Up to 85 percent of women of child bearing age present premenstrual symptoms. Only some of them meet criteria for Premenstrual Syndrome (PMS) and even less for premenstrual dysphoric disorder (PMDD). Both diseases begin in adolescence and are associated with negative consequences that interfere with daily functioning. Despite this, few adolescents consult for these symptoms, and when they consult, they do not get proper diagnosis and treatment. In this article we review the epidemiology, diagnosis and treatment of PMS and PMDD in adolescents. Education on lifestyle changes, healthy nutrition and exercise are the interventions most recommended in adolescents. In contrast, in adults, hormone therapy and psychotropic have greater evidence.

Desempenho neuropsicológico e ciclo menstrual: revisão da literatura / Neuropsychological performance and menstrual cycle: a literature review

Approximately 80% of all women of reproductive age experience psychological and physical changes associated with the premenstrual phase. Cognitive alterations are among the most common complaints. In this context, studies have assessed cognitive performance across the menstrual cycle in healthy women and also in women with premenstrual syndrome (PMS). The main objective of the present study was to review the literature on cognitive function in different phases of the menstrual cycle in women of reproductive age, both healthy and with PMS, in particular premenstrual dysphoric disorder (PMDD). We searched MEDLINE and LILACS databases. A total of 27 studies were selected. The studies used heterogeneous methodologies. Most studies suggested that healthy women show small fluctuations in cognitive performance across the menstrual cycle, with low performance scores in the luteal phase for visuospatial and motor skills, attention and concentration, verbal memory, visual memory, working memory, and reaction time. Among women with PMS or PMDD, low performance scores for visuospatial and motor skills, attention and concentration, verbal memory, working memory, reaction time and impulsivity were also detected in the luteal phase. Symptoms observed in PMS/PMDD patients showed low intensity, but greater when compared with healthy women. Evidence indicates fluctuations in cognitive performance in the different phases of the menstrual cycle in healthy and PMS women, with worse performance for women with PMS/PMDD in the luteal phase. However, methodological limitations prevent us from drawing solid conclusions. Further studies are needed to investigate the impact of these cognitive fluctuations on patients' daily activities.

Cerca de 80% das mulheres em idade fértil apresentam alterações psicológicas e físicas associadas à fase pré-menstrual. Dentre as queixas mais comuns estão as alterações cognitivas. Nesse contexto, tem-se estudado o desempenho cognitivo ao longo do ciclo menstrual de mulheres com e sem síndrome pré-menstrual (SPM). O objetivo principal deste estudo foi revisar a literatura acerca do desempenho das funções cognitivas nas diferentes fases do ciclo menstrual de mulheres em idade reprodutiva, sadias ou portadoras de SPM, em particular o transtorno disfórico pré-menstrual (TDPM). Foram revisadas as bases de dados MEDLINE e LILACS. Um total de 27 estudos foram selecionados. Os estudos eram heterogêneos em suas metodologias. Em sua maioria, os trabalhos evidenciaram que mulheres sadias apresentam variações leves no desempenho cognitivo ao longo do ciclo menstrual, obtendo menor pontuação, durante a fase lútea, nas habilidades visuoespaciais e motoras, atenção e concentração, memória verbal, memória visual, memória de trabalho e tempo de reação. Entre as mulheres com SPM ou TDPM, foi identificada, na fase lútea, redução no desempenho das habilidades visuoespaciais e motoras, atenção e concentração, memória verbal, memória de trabalho, tempo de reação e impulsividade. Tais sintomas apresentaram intensidade leve, porém superior à observada em mulheres sadias. As evidências indicam a existência de variações no desempenho cognitivo ao longo das diferentes fases do ciclo menstrual de mulheres sadias ou com SPM, com desempenho cognitivo pior em mulheres com SPM/TDPM na fase lútea. Entretanto, limitações metodológicas impedem conclusões sólidas. Novos estudos são necessários para investigar o impacto dessas oscilações cognitivas nas atividades cotidianas dos pacientes.

Síndrome pré-menstrual e transtorno disfórico pré-menstrual: atualização / Premenstrual syndrome and premenstrual dysphoric disorder: an update

A síndrome pré-menstrual é um conjunto de sinais e sintomas físicos, emocionais e comportamentais que ocorre durante a fase lútea do ciclo menstrual e atinge cerca de 40% das mulheres em idade fértil. O transtorno disfórico pré-menstrual afeta 5,8% das mulheres e é definido quando os sintomas pré-menstruais são suficientemente severos a ponto de afetar a qualidade de vida dessas pacientes em âmbito social, familiar e profissional. Há diversas opções de tratamento descritas na literatura para ambas as patologias, incluindo mudança no estilo de vida, suplementação alimentar, fitoterapia, medicamentos hormonais, supressores da ovulação, ansiolíticos, antidepressivos, entre outros. O objetivo deste artigo de revisão foi fornecer uma atualização acerca dessas doenças tão prevalentes entre as mulheres, pontuando aspectos clínicos relevantes e avaliando os tratamentos atualmente disponíveis sob a ótica da Medicina baseada em evidências.

Premenstrual syndrome is a group of physical, emotional and behavioral symptoms that happens during the luteal phase of the menstrual cycle and affects about 40% of women in their reproductive age. Premenstrual dysphoric disorder affects 5.8% of women and is defined when the premenstrual symptoms are severe enough to affect quality of life of patients in the social, familial and professional scopes. The treatment options described in literature for both diseases are vast, including change in lifestyle, diet supplementation, phytotherapy, hormonal drugs, ovulation suppressors, anxiolytics, antidepressant medications and others. The objective of this review article was to provide an update about these diseases which are among women, pointing out relevant clinical aspects and evaluating the current treatments available, according to evidence-based medicine.

Tensão pre-menstrual: reflexão sobre aspectos epidemiológicos / Premenstrual tension: reflexion over epidemilogical aspects

Neste artigo, apresentam-se alguns aspectos epidemiológicos considerados importantes para a melhor caracterização da condição conhecida como tensão pré-menstrual. A necessidade da padronização das definições e dos sintomas considerados no diagnóstico, assim como metodologias apropriadas para estudo de prevalência, são discutidos. Evidências sugerem que aspectos políticos, sociológicos e econômicos possam influenciar a crescente popularidade dessa condição. Dessa forma, estudos qualitativos são importantes para esclarecer as diferenças culturais na forma de perceber o desconforto na fase pré-menstrual. Devido à flutuação e intervariabilidade da apresentação de sintomas através do tempo, descrita em estudo de coorte, recomenda-se muito cuidado no seguimento e na prescrição de medicamentos em longo prazo, principalmente as que possam levar a dependência. Solicita-se à classe médica participar mais ativamente na educação, visando a modificar o discurso público atual sobre a tensão pré-menstrual

In this article we have presented some epidemiological aspects of the premenstrual syndrome. Better understanding and standardization of the definition, symptoms, and knowledge of the appropriate designs for prevalence studies have been briefly considered. Some researchers of the social area have pointed to political, economical, and sociological motives to explain the crescent popularization of this condition. Qualitative studies should be carried to clarify the cultural differences on how women perceive their premenstrual discomfort. Due to the high fluctuation and intra variability of the condition over time, demonstrated in a cohort study, it is recommended to the medical professional to do a careful follow-up and avoid long term prescriptions to their clients. It has also been requested to physicians, nurses and all involved in health care to participate more actively on the education in order to modify the actual public knowledge on the premenstrual syndrome.

Repercussões do transtorno disfórico pré-menstrual entre universitárias / Effects of premenstrual dysphoric disorder among college students

Introdução: O transtorno disfórico pré-menstrual (TDPM) é uma variante mais grave da síndrome pré-menstrual que apresenta a oscilação do humor como fator mais perturbador e debilitante, repercutindo na qualidade de vida das mulheres em idade reprodutiva. O objetivo deste estudo foi identificar as principais repercussões físicas e emocionais causadas pela TDPM entre universitárias de Fisioterapia. Método: Estudo do tipo corte transversal, descritivo e analítico, realizado no período de agosto a dezembro de 2008 em 259 universitárias. Os instrumentos utilizados para a realização desta pesquisa foram: um questionário contendo questões socioeconômicas, o Questionário de Sintomas Menstruais (Menstrual Symptom Questionnaire, MSQ), a escala de autoavaliação de síndrome de transtorno pré-menstrual de Steiner e o Questionário de Autoavaliação da Escala de Hamilton para Depressão. A análise estatística foi descritiva e analítica, sendo utilizado o teste qui-quadrado ou o teste exato de Fisher, sendo que todas as conclusões foram tomadas ao nível de significância de 5%. Resultados: Encontramos alta prevalência de repercussões somáticas e emocionais. Através dos sinais e sintomas pesquisados pelo MSQ entre as portadoras de TDPM, observou-se uma associação do transtorno com os sintomas depressivos (p = 0,048). Os demais sintomas como ansiedade, labilidade de humor, sintomas somáticos, habilidade para realizar tarefas e dor não apresentaram correlação. Conclusão: O TDPM provocou desconforto físico e emocional e revelou uma correlação significativa com os sintomas depressivos, sugerindo tratar-se de uma expressão clínica de transtorno de humor.

Background: Maternal premenstrual dysphoric disorder (PMDD) is a severe variant of premenstrual syndrome in which mood swings are the most disturbing and debilitating, affecting the quality of life of women of reproductive age. The objective of this study was to identify the main physical and emotional manifestations of PMDD among undergraduate students of Physical Therapy. Methods: A cross-sectional, descriptive, analytical study was carried between August and December 2008, with 259 undergraduate students. The following instruments were used: a questionnaire covering social and economic data; the Menstrual Symptom Questionnaire (MSQ); Steiner’s selfrated premenstrual syndrome questionnaire; and the Hamilton Self-Rating Depression Questionnaire. Descriptive and analytical statistical analysis was performed using the chi-square test or Fisher’s exact test. Significance was set at 5%. Results: A high prevalence of physical and emotional symptoms was found. Among the signs and symptoms assessed by MSQ, only depression showed a significant correlation with PMDD (p = 0.048). Other symptoms, such as anxiety, mood lability, physical symptoms, the ability to perform daily tasks, and pain, were not correlated with PMDD. Conclusion: PMDD caused physical and emotional distress among the women assessed and was significantly correlated with depression. These findings suggest that PMDD should be classified as a clinical manifestation of mood disorders.