Letters to the Editor
Distress Levels in Patients With Premenstrual Dysphoric Disorder
Dear Editor:
It is estimated that 75% of women of reproductive age experience premenstrual syndrome (PMS) (1), which includes emotional, physical, and behavioural changes. However, only 3% to 8% experience premenstrual dysphoric disorder (PMDD) (2)—severe premenstrual mood symptoms that interfere with normal daily functioning (work, social activities, and relationships) (3). The chronological relation of symptoms and the menstrual cycle has been investigated (4), as have been medications and lifestyle modifications for PMS and PMDD (2). The effect of medication on psychosocial functioning in PMDD patients has also been evaluated (5,6), but few studies have systematically looked at the impact of symptoms on lifestyle and daily functioning in subjects with PMDD, compared with control subjects (7).
Daily self-rating forms that record symptoms and severity are widely used to confirm the diagnosis of PMS or PMDD, but there are no specific questionnaires to measure psychosocial functioning in PMDD (7). Therefore, we studied levels of distress, degrees of impairment, and impact on lifestyle in women with PMDD, compared with a control group. We used 3 validated self-rating scales: the Symptom Questionnaire (SQ) (8), the Sheehan Disability Scale (9), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) Short Form (10) as applied to premenstrual symptoms. Subjects diagnosed with PMDD (n = 15) and control subjects (n = 15) gave written informed consent and completed the self-rating questionnaires (once only) during the luteal phase. They also reported general demographic data and menstrual history. We conducted independent t-tests to determine the effect of PMDD as measured by the self-rating scales; preliminary findings show significant between-group differences in the mean total scores of distress levels, functional impairment, and quality of life.
Our study results indicate that women with PMDD report more distress and impairment and less satisfaction during the luteal phase, compared with the control subjects. However, these results should be viewed with caution, because there were few participants, the questionnaires were only completed once, and the measures were not designed specifically for PMDD. The study also did not take into account unusual current stressors that might have magnified symptom severity and possibly influenced the self-rating scores. These study findings, however, do suggest that the impact of PMDD on psychosocial functioning can be measured systematically by self-rating questionnaires. The preliminary results of the SQ support the view that mood symptoms, and not physical symptoms, characterize women with PMDD (2) and that there is a correlation between psychosocial functioning and the mood symptoms (4) measured by these 3 questionnaires.
Prospective daily charting of symptoms is crucial to establish the diagnosis of PMDD, but measuring psychosocial functioning may also help to confirm severity and assist in treatment recommendations (for example, medication, lifestyle changes, or alternative therapies). We encourage a larger study using accepted, standardized ratings of psychosocial functioning in relation to PMDD.
References
1. Johnson SR, McChesney C, Bean JA. Epidemiology of premenstrual symptoms in a nonclinical sample. J Reprod Med 1988;33:340–6.
2. Steiner M. Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. J Psychiatr Neurosci 2000;25:459–68.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association; 1994. p 715–8.
4. Bloch M, Schmidt PJ, Rubinow DR. Premenstrual syndrome: evidence for symptom stability across cycles. Am J Psychiatry 1997;154:1741–6.
5. Pearlstein TB, Halbreich U, Batzar ED, Brown CS, Endicott J, Frank E, and others. Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatry 2000;61:101–9.
6. Yonkers KA, Halbreich U, Freeman E, Brown C, Endicott J, Frank E, and others. Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment: a randomized controlled study. JAMA 1997;278:983–8.
7. Freeman EW, Halbreich U. Premenstrual syndromes. Psychopharmacol Bull 1998;34:291–5.
8. Kellner R. A symptom questionnaire. J Clin Psychiatry 1987;48:268–74.
9. Leon AC, Olfson M, Portera L, Faber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan disability scale. Int J Psychiatry Med 1997;27(2):93–105.
10. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull 1993;29:321–6.
Annie J Kuan, BA
Diana MG Carter, MD, CRCPC
Fred J Ott, OT
Vancouver, British Columbia
|
