Premenstrual Psychosis

by Dr. Lorin Bradbury

Question: I don’t exactly have a question, but could you please write about Premenstrual Psychosis?

Answer: This is an area in psychiatric/psychological care that I have very little experience. So I had to do a bit of research to even be able to address the subject.

In 2015 Roberta Zanzonico, MD and Derick E. Vergne, MD wrote an article titled Menstrual Psychosis: A Forgotten Disorder?

They described the condition as a rare disorder that is often not recognized by physicians and mental health professionals. The time frame in which it occurs is usually three days before and three days after the first day of menses and it can result in florid psychoses. It was originally reported in the late 1800s by v. Krafft-Ebing, and in 1998, Ian Brockington, MD, Psychiatrist, published an extensive review with 275 subjects. However, since that time, awareness of the condition by physicians has waned, and many are unaware of it.

Menstrual psychosis has the following characteristics: 1. Acute onset; 2. Brief duration, with full recovery; 3. The presence of psychotic features, such as confusion, stupor, and mutism, delusions, hallucinations, or a manic syndrome; 4. Occurs approximately monthly in rhythm with the menstrual cycle.

The difference between Menstrual Psychosis and other psychotic disorders, such as Schizophrenia, is that is quickly goes into remission and there is no loss of cognitive functioning following each episode. The manic syndrome noted above may include intense irritability and expression of angry feelings as symptoms.

The condition is not found in latest revision of Diagnostic and Statistical Manual (DSM-5). The closest diagnosis in the DSM-5 might be Premenstrual Dysphoric Disorder. That condition is listed under the category of Depressive Disorders, and it is believed to be related to fluctuation of ovarian hormones and serotonin. Since Premenstrual Dysphoric Disorder is a depressive disorder, I am going to make an assumption that psychotic features could be present, and if so they should be noted.

As a side note, just because it did not make it into the latest revision of the DSM does not mean it is not a real condition that can be overlooked or ignored. A thorough evaluation to rule out other possible medical/psychiatric disorders is suggested.

Lorin L. Bradbury, Ph.D. is a licensed psychologist in private practice in Bethel. For appointments, he can be reached at 543-3266. If you have questions that you would like Dr. Bradbury to answer in the Delta Discovery, please send them to The Delta Discovery, P.O. Box 1028, Bethel, AK 99559, or e-mail them to [email protected].