A Diagnosis with Little Awareness in Adolescence: Menstrual Psychosis

Abstract

Menstrual psychosis has been described as a brief psychotic episode acute in its onset, rapid in its resolution, and marked by variable temporal boundaries within the menstrual cycle. It is a rare disorder with a crudely estimated prevalence of 1 in 10,000. To confirm a case with menstrual psychosis clinically, detailed dates regarding the association of the menstrual cycle and psychosis are necessary. Menstrual psychosis occurs most commonly in phases of the menstrual cycle where estrogen levels are low. It is thought to be caused by increased dopamine sensitivity during the low estrogen phases of the menstrual cycle. The mainstay of pharmacological treatment in menstrual psychosis is neuroleptics, mood stabilizers, and hormonal therapy. Antipsychotics and antidepressants have been reported to be helpful during acute psychotic states in menstrual psychoses, but have not been documented as successful monotherapy in the prevention of further episodes in the treatment of menstrual psychoses. Severe affective instability with evident psychosis during the menstrual cycle should be evaluated for menstrual psychosis. Further research is needed to describe most aspects of the disorder, including prevalence, pathophysiology, genetic risk, and evidence-based therapies. Menstrual psychosis is a distinct category of mental illness that should be managed by a multidisciplinary team. Education on menstrual psychosis should also be increased as it is likely to be missed clinically. Increased identification is important as the treatment is effective, and safe.

Keywords

• adolescent
• menstruation
• psychosis