LIST REFERENCES LIST REFERENCES A) PREMENSTRUAL... 1481 E) 1987...88 220500 B) PREMENSTRUAL ... 939 F) *ON D&E 43 C) ABSTRACT ONLINE 1725807 G) PREMENSTRUAL SYNDROME 200 D) *ON B&C 400 H) PREMENSTRUAL SYNDROME 200 *** *** *****ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA***** Kullander S Svanberg L Bromocriptine treatment of the premenstrual syndrome. ACTA OBSTET GYNECOL SCAND 1979; 58(4):375-8 Bromocriptine, 2.5 mg twice a day was tested for its effect on premenstrual tension in a random double-blind cross-over trial. 1. The compound tended to lessen the symptoms, especially mastodynia. 2. Serum prolactin levels around the upper limit of the normal range were significantly lowered. Patients with the highest starting prolaction levels had the most severe symptoms and in these patients the fall in the levels was greatest. 3. Serum FSH and LH levels were significantly reciprocally influenced compared with serum prolactin. Serum estradiol-17-beta and progesterone did not change during treatment. 4. The bromocriptine-treated cycles were all ovulatory according to basal temperature levels. The luteal phase was prolonged when serum FSH was raised. Hagen I Nesheim BI Tuntland T No effect of vitamin B-6 against premenstrual tension. A controlled clinical study. ACTA OBSTET GYNECOL SCAND 1985; 64(8):667-70 Vitamin B-6 100 mg given daily throughout the menstrual cycle was compared with placebo in a randomized, double-blind crossover trial in 34 women who suffered from premenstrual tension. Vitamin B-6 was no better than placebo. There was a substantial period effect, as the women evidenced a considerable preference for the second drug they received, irrespective of whether this was vitamin B-6 or placebo. Blood magnesium was measured; no significant difference was found between the 34 women with premenstrual tension and 10 healthy women without such complaints. Vitamin B-6 caused a small but statistically significant rise in blood magnesium level. In the individual patients, no correlation was found between changes in blood magnesium and premenstrual symptoms. Central Institute for Industrial Research Oslo Norway Hammarback S Backstrom T Holst J von Schoultz B Lyrenas S Cyclical mood changes as in the premenstrual tension syndrome during sequential estrogen-progestagen postmenopausal replacement therapy. ACTA OBSTET GYNECOL SCAND 1985; 64(5):393-7 The etiology of the cyclical mood changes seen in the premenstrual syndrome is still unknown. A close relation to the luteal phase has been shown. One of the differences between the follicular and the luteal phase is the higher plasma progesterone concentration during the luteal phase. The present investigation has been conducted to study the effect of exogenously administered estrogen/gestagen sequential postmenopausal replacement therapy on mood and physical signs. Twenty-two women requiring postmenopausal estrogen treatment were recruited and divided into two groups. Eleven women were given estradiol treatment only (Oestrogel creme 3 mg percutaneously/day) for 21 days with a subsequent break of 7 days. The other 11 women were in addition given progestagen (Lynestrenol, Orgametril 5 mg/day) during the last 11 days of treatment. The women were asked to keep a daily record of their mood, using a visual analogue scale earlier tested in women with premenstrual syndrome. They also kept a record of physical signs and sexual feelings. The records were kept for between one and 6 months. The group with estrogen treatment only did not show any cyclical worsening in mood or physical signs during the treatment. The women who in the latter stage of the estrogen treatment cycle also received progestagen, showed significant cyclicity in both moods and physical signs, with a maximum symptom degree during the final days of gestagen treatment. The negative mood change started 1-3 days after the progestagen was added to the treatment. The results suggest that progestagens are involved in the provocation of cyclical symptom changes seen in the premenstrual syndrome. Department of Obstetrics and Gynecology University of Ume~a Sweden *****AMERICAN FAMILY PHYSICIAN/GP***** Laughlin M Johnson RE Premenstrual syndrome. AM FAM PHYSICIAN 1984 Mar; 29(3):265-9 Premenstrual syndrome is a chronic cyclic disorder with a broad range of morbidity. The syndrome encompasses emotional, behavioral and physical symptoms, usually beginning in the week before menses and ending at the onset of menses or shortly thereafter. To date, the etiology and the most effective treatment are unknown; however, vitamin B6, progesterone and bromocriptine therapies have been advocated. Jay MS Taylor W Primary dysmenorrhea: current concepts. AM FAM PHYSICIAN 1981 Nov; 24(5):129-34 Primary dysmenorrhea is menstrual pain that is not associated with pelvis pathology. It usually begins with the onset of ovulatory cycles, characteristically appearing in the year after menarche and increasing with time. The pain is associated with increased myometrial activity. Oral contraceptives and prostaglandin synthetase inhibitors are effective in alleviating symptoms. Causes of secondary dysmenorrhea, such as pelvic inflammatory disease, endometriosis and uterine myomas, must be excluded before treatment is given. Price WA Dimarzio LR Gardner PR Biopsychosocial approach to premenstrual syndrome. AM FAM PHYSICIAN 1986 Jun; 33(6):117-22 Premenstrual syndrome is a constellation of behavioral, physical and psychologic symptoms that occur every 28 days in some women of childbearing age. A multidimensional, biopsychosocial approach, combining stress reduction, increased exercise and proper diet, has been found effective in treating this syndrome. Medications can be added to relieve symptoms. The cornerstone of this approach is empathic understanding. Northeastern Ohio Universities College of Medicine Rootstown *****AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY***** Faratian B Gaspar A OBrien PM Johnson IR Filshie GM Prescott P Premenstrual syndrome: weight, abdominal swelling, and perceived body image. AM J OBSTET GYNECOL 1984 Sep 15; 150(2):200-4 One hundred forty-eight menstrual cycles were studied in 52 women, and in each cycle various parameters were measured to determine an objective means of assessing the syndrome. Daily mood assessment, body weight, plasma 17 beta-estradiol levels, and plasma progesterone levels were measured. The abdominal dimensions were measured in the lateral and anteroposterior diameters at the level of the umbilicus and 10 cm below; at the same time the same dimensions were measured as perceived by the patient. Mood score showed a marked increase during the premenstrual phase of each cycle. The symptom of bloatedness was marked during the premenstrual phase of the cycle. Despite these highly elevated scores for bloatedness there was no increase in body weight or the measured body dimensions in any plane. However, the patient's perception of body size did increase, and the discrepancy between the perceived body size and the actual body size (perception error) was significant. Reid RL Yen SS Premenstrual syndrome. AM J OBSTET GYNECOL 1981 Jan; 139(1):85-104 The premenstrual syndrome (PMS) is a major clinical entity afflicting a large segment of the female population. Available information are descriptive in nature and the etiology of this syndrome remains unclear. In this review, both biochemical and psychosocial elements of the syndrome have been explored in an effort to redefine the pathophysiology of this seemingly multifactorial psychoneuroendocrine dysfunction. We propose that luteal phase sensitivity to and subsequent withdrawal from the central effects of the neuropeptides beta-endorphin and alpha-melanocyte-stimulating hormone result in a cascade of neuroendocrine changes within the brain-hypothalamus- pituitary complex. Modulation of neurotransmitter function by these peptides may produce alterations in mood and behavior as well as enhance pituitary release of prolactin and vasopressin. Variable gonadal steroid modulation of these responses from subject to subject likely accounts for the heterogeneous clinical manifestations of the PMS. Posthuma BW Bass MJ Bull SB Nisker JA Detecting changes in functional ability in women with premenstrual syndrome. AM J OBSTET GYNECOL 1987 Feb; 156(2):275-8 There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test--Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test-Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome. Department of Occupational Therapy University of Western Ontario London Canada. Reid RL Premenstrual syndrome: a time for introspection. AM J OBSTET GYNECOL 1986 Nov; 155(5):921-6 Premenstrual syndrome has emerged as an important reproductive health care issue amid heated debate about whether such a condition, in fact, exists. Polarization of opinion on this issue has been the result of imprecision in the definition of premenstrual syndrome, leading to inappropriate generalization of the disruptive physical, emotional, or behavioral changes of premenstrual syndrome to the entire female population. A shortage of reliable scientific information on premenstrual syndrome has led to inconsistent, and often ineffective, medical intervention by a sometimes skeptical medical profession. Examination of individual biases and the external factors that have influenced our thinking on this issue may allow us to more clearly define our role as a specialty in the ongoing investigations and management of menstrual cycle-related illnesses. Department of Obstetrics and Gynaecology Queen's University Kingston Ontario Canada. Casper RF Powell AM Premenstrual syndrome: documentation by a linear analog scale compared with two descriptive scales. AM J OBSTET GYNECOL 1986 Oct; 155(4):862-7 We examined the use of a six-item linear analog scoring system comprised of three somatic and three mood-related items for the documentation of premenstrual syndrome. One hundred forty women with suspected premenstrual syndrome completed the linear analog scale, as well as the validated 36-item Self-Rating Scale for Premenstrual Tension Syndrome and the 35-item Prospective Record of the Impact and Severity of Menstrual Symptomatology calendar. Ninety patients and 20 normal control subjects completed two cycles of records. With use of clinical criteria and self-rating scale scores as the "gold standard," 73 patients were diagnosed as having premenstrual syndrome. Linear analog scale scores were highly correlated with both self-rating scale scores (r = 0.72, day 9; r = .66, day 27; p = 0.001) and prospective record scores (r = 0.74, day 9; r = 0.60, day 27; p = 0.001). Our results suggest that the linear analog scale may be a useful clinical tool in the study of premenstrual syndrome. Because of its simplicity, the linear analog scale may increase patient compliance. Because of its sensitivity to detect changes in symptom severity throughout the menstrual cycle, it may prove useful in evaluating the effects of therapy for premenstrual syndrome. Department of Obstetrics and Gynecology and Physiology University of Western Ontario London Canada. Magos AL Brincat M Studd JW Trend analysis of the symptoms of 150 women with a history of the premenstrual syndrome. AM J OBSTET GYNECOL 1986 Aug; 155(2):277-82 The daily symptom records of 150 untreated women with a convincing history of the premenstrual syndrome were investigated qualitatively and quantitatively by means of time series analysis in the form of Trigg's technique for trends. Symptoms were monitored with use of a modified menstrual distress questionnaire. Analysis showed that, depending on the symptom cluster, 60.7% to 85.3% of the women showed symptom trends consistent with the syndrome, 14.0% to 35.3% had trends not typical of the syndrome, and in 0% to 5.3% of records significant trends were absent. Since over 80% of the women were found to have premenstrual syndrome trends for three or more of the six symptom clusters studied, including 32% who showed this trend pattern for all symptoms, a retrospective history of premenstrual syndrome is likely to be confirmed on prospective assessment for at least some symptoms. Quantitatively women who fulfilled the diagnostic criteria for premenstrual syndrome differed from those who did not by exhibiting significantly greater exacerbation of symptoms premenstrually and lesser morbidity postmenstrually. While water retention, negative affect, and pain were the three symptom clusters associated with the most severe ratings, the majority of women suffered from a mixture of physical, psychological, and behavioral complaints, and it was not possible to subdivide the study group by the type of symptoms. Department of Gynecology Dulwich Hospital London, England Magos AL Studd JW Assessment of menstrual cycle symptoms by trend analysis. AM J OBSTET GYNECOL 1986 Aug; 155(2):271-7 The physical, psychological, and behavioral changes associated with the menstrual cycle can be assessed statistically by time series analysis. One such method, Trigg's technique for trends, has been adapted for the study of prospective symptom ratings used in evaluation of the premenstrual syndrome. Such analysis provides both qualitative and quantitative information concerning menstrual cycle symptomatology. The pattern of symptoms, as denoted by Trigg's tracking signal, can be identified. The premenstrual syndrome can be defined mathematically in terms of significant symptom trends at specified times in the menstrual cycle. The overall severity of symptoms at any point in the cycle can be gauged by the exponentially smoothed average symptom ratings. A derived statistic, the menstrual cycle ratio, is proposed as a global index of menstrual cycle morbidity which can be easily standardized to allow for comparability of research reports. Department of Gynecology Dulwich Hospital London, England Pariser SF Stern SL Shank ML Falko JM OShaughnessy RW Friedman CI Premenstrual syndrome: concerns, controversies, and treatment. AM J OBSTET GYNECOL 1985 Nov 15; 153(6):599-604 Premenstrual syndrome is of interest to health care professionals today because of media attention and large numbers of women who are concerned about their premenstrual symptoms. At the same time, there is a lack of consensus as to diagnostic criteria and specific treatment. There appears to be a relationship between mood disorders such as major depression and luteal phase symptoms. An approach to the diagnosis and treatment of the patient with premenstrual syndrome is described. Department of Obstetrics and Gynecology Ohio State University College of Medicine Columbus *****AMERICAN JOURNAL OF PSYCHIATRY***** Rubinow DR Roy-Byrne P Hoban MC Gold PW Post RM Prospective assessment of menstrually related mood disorders. AM J PSYCHIATRY 1984 May; 141(5):684-6 For prospective longitudinal confirmation of menstrually related mood changes, the authors selected a 100-mm visual analogue scale for twice-daily self-rating of mood. The advantages of this method are simplicity; increased compliance; ease of graphic presentation, allowing evaluation of severity and relationship to menstruation; and greater uniformity among studies of menstrually related syndromes. In a preliminary application of this measure to 20 women with self- diagnosed premenstrual syndrome, eight (40%) had a mean depression rating during the week before menstruation that was 30% higher than during the week after cessation of menstruation. Rubinow DR Roy-Byrne P Premenstrual syndromes: overview from a methodologic perspective. AM J PSYCHIATRY 1984 Feb; 141(2):163-72 The authors review the available evidence regarding the nature, cause, and treatment of the premenstrual syndromes. They attribute the contradictory results of various studies and the current theoretical confusion in the area to the failure of investigators to carefully define the syndromes, formulate a set of answerable questions, and select a homogeneous population before initiating their studies. The relationship between premenstrual syndromes and major psychiatric disorders, as well as the clinical and theoretical relevance of the menstrual cycle to major psychiatric disorders, is discussed. The authors offer recommendations to both investigators and clinicians for more careful observation and documentation of the relationship between mood disorders and the menstrual cycle. Parry BL Wehr TA Therapeutic effect of sleep deprivation in patients with premenstrual syndrome. AM J PSYCHIATRY 1987 Jun; 144(6):808-10 Eight of 10 women with premenstrual depression responded to one night's total sleep deprivation and maintained their improvement after a night of recovery sleep. In responders, subsequent late-night partial sleep deprivation was more effective than early-night deprivation. Clinical Psychobiology Branch NIMH Bethesda MD 20205. Parry BL Rosenthal NE Tamarkin L Wehr TA Treatment of a patient with seasonal premenstrual syndrome. AM J PSYCHIATRY 1987 Jun; 144(6):762-6 The authors identified a patient who had premenstrual syndrome (late luteal phase dysphoric disorder) only in the fall and winter and was virtually asymptomatic during the spring and summer. On the basis of previous experience with seasonal affective disorder, they treated the patient with bright artificial light, which reversed her symptoms. On subsequent occasions they reversed this treatment effect with oral melatonin administration and found that propranolol and atenolol, beta-antagonists that inhibit the production of melatonin, had a therapeutic effect similar to that of light. They discuss the implications of these findings in relation to the importance of melatonin as a mediator of seasonal rhythms in biology. Clinical Psychobiology Branch NIMH Bethesda MD 20205. DeJong R Rubinow DR Roy-Byrne P Hoban MC Grover GN Post RM Premenstrual mood disorder and psychiatric illness. AM J PSYCHIATRY 1985 Nov; 142(11):1359-61 The results of several studies suggest that a special relationship exists between premenstrual syndromes and major psychiatric disorders, particularly affective illness. These studies in general have not employed prospective criteria to diagnose premenstrual syndrome. In this paper the authors report a significant difference in the lifetime history of psychiatric illness between women with prospectively confirmed menstrually related mood disorder and those without it. Biological Psychiatry Branch NIMH Bethesda, MD 20205 *****AMERICAN JOURNAL OF PUBLIC HEALTH***** Woods NF Most A Dery GK Prevalene of perimenstrual symptoms. AM J PUBLIC HEALTH 1982 Nov; 72(11):1257-64 The purpose of this study was to determine the prevalence of perimenstrual symptoms (PMS) in a free-living population of US women and to determine if prevalence estimates varied with parity, contraceptive status, characteristics of the menstrual cycle, and selected demographic variables. We identified all households from a census listing for five southeastern city neighborhoods that offered variation in racial composition and socioeconomic status. We ascertained all households in which there was one nonpregnant woman between the ages of 18 and 35 years per household. Of the 241 eligible women, 179 (74 per cent) participated in the study. Trained interviewers administered the Moos Menstrual Distress Questionnaire (MDQ) and other demographic measures to women between March and July 1979. Symptoms with a prevalence greater than 30 per cent included weight gain, headache, skin disorders, cramps, anxiety, backache, fatigue, painful breasts, irritability, mood swings, depression, or tension. Only 2 to 8 per cent of women found most of these severe or disabling. The exceptions were severe cramps reported by 17 per cent of women and severe premenstrual and menstrual irritability by 12 per cent. Cramps, backaches, fatigue, and tension were most prevalent during the menstruum; weight gain, skin disorders, painful breasts, swelling, irritability, mood swings, and depression were more prevalent in the premenstruum. Parity, oral contraceptive use, age, employment, education, and income were negatively associated with selected PMS. Use of an IUD, having long menstrual cycles, long menstrual flow, or heavy menstrual flow, and being able to predict the next period were positively associated with selected PMS. Race had both positive and negative effects on PMS. Boyle CA Berkowitz GS Kelsey JL Epidemiology of premenstrual symptoms. AM J PUBLIC HEALTH 1987 Mar; 77(3):349-50 We examined the prevalence of selected premenstrual symptoms among 520 Connecticut women in relation to demographic, reproductive, contraceptive, and medical characteristics. The prevalence ranged from 39 per cent for breast swelling to 81 per cent for premenstrual weight gain. Socioeconomic status, race, history of benign breast disease, bra cup size, and history of abortions were some of the factors associated with premenstrual symptoms. Department of Epidemiology and Public Health Yale University School of Medicine. *****ARCHIVES OF GENERAL PSYCHIATRY***** Halbreich U Endicott J Nee J Premenstrual depressive changes. Value of differentiation. ARCH GEN PSYCHIATRY 1983 May; 40(5):535-42 Premenstrual depressive changes and differential correlates of specific subtypes of premenstrual dysphoria vary. Our data support two basic assumptions: (1) Premenstrual changes should be studied as diversified subtypes rather than as a single premenstrual tension syndrome; such an approach might lead to a better understanding of the pathophysiology of specific types of premenstrual changes. (2) Some specific subtypes of premenstrual changes of a depressive nature resemble some subtypes of affective disorder and, hence, may serve as a model for the study of these disorders. *****AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY***** Wood C Larsen L Williams R Social and psychological factors in relation to premenstrual tension and menstrual pain. AUST NZ J OBSTET GYNAECOL 1979 May; 19(2):111-5 Age, country of birth, marital status, attitude to work, smoking and drinking habits, childbearing, sex life and psychological factors are all linked to the frequency of menstrual pain and premenstrual tension. The relationship between the psychosocial and menstrual characteristics may be causal or related to some other constitutional factor (or factors) which determines both. The profile of women suffering from premenstrual tension and menstrual pain is described. In management, associated psychosocial factors and the relationship betweem these and the described menstrual problems needs to be taken into account. *****BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY***** Jakubowicz DL Godard E Dewhurst J The treatment of premenstrual tension with mefenamic acid: analysis of prostaglandin concentrations. BR J OBSTET GYNAECOL 1984 Jan; 91(1):78-84 Eighty patients with premenstrual tension were treated prospectively with mefenamic acid for a mean period of 13 months. Most of them (86%) reported significant relief of premenstrual tension. Symptoms of dysfunctional menorrhagia or primary dysmenorrhoea were also alleviated. In 19 patients, the plasma concentrations of prostaglandin (PG) E2, PGF2 alpha and 13,14-dihydro-15-keto- prostaglandin F2 alpha (PGFM) were measured at intervals throughout three menstrual cycles. During the first cycle the patients received no treatment; in the subsequent two cycles they received either mefenamic acid or placebo in a randomized double-blind crossover manner. Similar measurements were made in 22 matched control subjects. The plasma concentrations of PGE2, PGF2 alpha and PGFM were significantly lower in the 19 patients in all three menstrual cycles compared with the values in the control subjects. Excess synthesis of prostaglandins of the 1 series may occur in premenstrual tension and, by precursor depletion, result in decreased synthesis of the 2-series prostaglandins. Wood C Jakubowicz D The treatment of premenstrual symptoms with mefenamic acid. BR J OBSTET GYNAECOL 1980 Jul; 87(7):627-30 Thirty-seven patients suffering from premenstrual symptoms were each studied through three menstrual cycles. After a control cycle, mefenamic acid and placebo were given during the luteal phase of the cycle in a random double-blind cross over manner, each patient serving as her own control. The dosage of mefenamic acid was 500 mg thrice daily. Medication significantly improved premenstrual symptoms, particularly tension, irritability, depression, pain and headache. It was not effective for breast symptoms. Most patients complaining of premenstrual symptoms also had menstrual symptoms, which were also improved by the mefenamic acid. OBrien PM Craven D Selby C Symonds EM Treatment of premenstrual syndrome by spironolactone. BR J OBSTET GYNAECOL 1979 Feb; 86(2):142-7 Spironlactone was given to 28 women in a double blind cross over trial during four menstrual cycles. Hormonal profiles were measured during the first two cycles. Plasma aldosterone was elevated in the premenstrual phase of the cycles but there was no significant difference between symptomatic and asymptomatic groups. The rise in serum progesterone was higher in the symptomatic group during the postovulatory phase. The administration of spironolactone reduced weight and relieved psychological symptoms in more than 80 per cent of the symptomatic group. Robinson K Huntington KM Wallace MG Treatment of the premenstrual syndrome. BR J OBSTET GYNAECOL 1977 Oct; 84(10):784-8 A placebo-controlled, randomized, double-blind, parallel group study in hospital and general practice has shown that a combination of belladonna alkaloids, ergotamine tartrate, and phenobarbitone (Bellergal) was effective in treating troublesome symptoms of the premenstrual syndrome of which fatigue, tender breasts, nervousness, irritability, lethargy and listlessness were improved to a statistically significant degree. The drug was given three times daily and caused no side effects. Andersen AN Larsen JF Steenstrup OR Svendstrup B Nielsen J Effect of bromocriptine on the premenstrual syndrome. A double-blind clinical trial. BR J OBSTET GYNAECOL 1977 May; 84(5):370-4 Twenty-one patients suffering from the premenstrual syndrome were each studied during three menstrual cycles. After a control cycle, bromocriptine and placebo were given during the luteal phase of the cycle in a random double-blind cross-over manner, each patient serving as her own control. The dosage of bromocriptine was 2-5 mg twice daily. Serum prolactin levels were found to equal during the follicular and luteal phases, except when reduced by bromocriptine. Serum progesterone and oestradiol-17-beta were within normal ranges, and did not change during treatment. Medication considerably improved all the premenstrual symptoms, but mastodynia was the only one where bromocriptine was significantly better than the placebo. Watts JF Butt WR Logan Edwards R A clinical trial using danazol for the treatment of premenstrual tension. BR J OBSTET GYNAECOL 1987 Jan; 94(1):30-4 Forty women with premenstrual tension received either placebo, 100, 200 or 400 mg danazol daily for 3 months in a pilot study arranged as a double-blind trial. Thirteen patients withdrew by the third month usually because they complained of no improvement. They had significantly higher pretrial symptom scores than those who continued. In patients treated with danazol, symptom scores for breast pain during the second and third months and for irritability, anxiety and lethargy during the third month were significantly (P less than 0.05) lower than scores in those given placebo. Most symptoms improved on placebo in the first month but by the third month only three remained improved. In contrast eight symptoms were improved on 200 mg danazol by the third month. By the end of the trial more than 75% of patients who were still taking danazol were essentially free of breast pain, lethargy, anxiety and increased appetite, but results for other common symptoms were no better than with placebo. Department of Clinical Endocrinology Birmingham and Midland Hospital for Women. Tulenheimo A Laatikainen T Salminen K Plasma beta-endorphin immunoreactivity in premenstrual tension. BR J OBSTET GYNAECOL 1987 Jan; 94(1):26-9 Plasma samples were collected twice during the follicular phase and three times during the luteal phase of the menstrual cycle in 12 women with premenstrual tension (PMT) and in 14 control subjects without symptoms. Concentrations of beta-endorphin (beta-E) immunoreactivity, cortisol, oestradiol, progesterone and LH were determined. Comparison of the mean concentrations of LH, cortisol, oestradiol and progesterone did not reveal any statistically significant differences between the PMT and the control groups. In the early luteal phase, the mean plasma beta-E immunoreactivity was lower in the PMT group (10.7, SE 0.7 pg/ml) than in the control group (14.6, SE 1.6 pg/ml, P less than 0.05), suggesting that endorphin secretion is decreased in PMT. No significant change in the plasma beta-E level was found in the PMT patients between the follicular and luteal phase when symptoms appeared. This does not exclude the possibility that in the central nervous system abnormal changes occur in the activity of endogenous opioids in PMT. Department I of Obstetrics and Gynaecology Helsinki University Central Hospital Finland. *****BRITISH JOURNAL OF PSYCHIATRY***** Sampson GA Prescott P The assessment of the symptoms of premenstrual syndrome and their response to therapy. BR J PSYCHIATRY 1981 May; 138:399-405 The symptoms of premenstrual syndrome should be rated daily, or at frequent intervals throughout the menstrual cycle. Self-rating is usually most feasible and separate rating of differing symptom groups is important, as symptoms differ in their response to therapy. Daily scores should be analysed to assess periodicity, either by subdividing the cycle into phases or by using the least mean square method of fitting sine waves. Standardized scores enable data to be compared across cycles. In a clinical trial it is important to include an untreated cycle to assess whether the subject has premenstrual syndrome and as a baseline with which to compare treated cycles. Allowance should be made for a carry-over effect and for high placebo response. One solution is to use a change-over design balanced for carry-over effects. The criteria used to define a patient should be stated. Sampson GA Jenner FA Studies of daily recordings from the Moos Menstrual Distress Questionnaire. BR J PSYCHIATRY 1977 Mar; 130:265-71 Nineteen volunteers completed a Moos Menstrual Distress Questionnaire daily for a period exceeding one menstrual cycle. The data were analysed, using a least mean square method of fitting sine waves. The fact that the results obtained on this group are essentially those found by other workers looking at the menstrual cycle suggests that this may be a useful method for assessing menstrual distress. Wetzel RD Reich T McClure Jr JN Wald JA Premenstrual affective syndrome and affective disorder. BR J PSYCHIATRY 1975 Sep; 127:219-21 Sixty-four per cent of 874 freshmen and sophomore women sent questionnaires about premenstrual and menstrual symptoms returned them. They differed from those not returning the questionnaires only in year of school. As predicted, women reporting premenstrual affective symptoms were more likely than those who did not report them to seek psychiatric care at the Student Health Service and to be diagnosed as affective disorder at the service. *****BRITISH MEDICAL JOURNAL [CLINICAL RESEARCH ED.]***** Massil H OBrien PM Premenstrual syndrome. BR MED J [CLIN RES] 1986 Nov 15; 293(6557):1289-92 Academic Department of Obstetrics and Gynaecology Royal Free Hospital London. *****CANADIAN MEDICAL ASSOCIATION JOURNAL***** Ghadirian AM Kamaraju LS Premenstrual mood changes in affective disorders. CAN MED ASSOC J 1987 May 15; 136(10):1027-32 Mood changes during the premenstrual phase have been the focus of considerable research in recent years. Although there has been significant progress in the diagnosis and etiology of major affective disorders, the relation between these disorders and menstrual changes remains controversial. There have been contradictory reports and speculations on women's susceptibility to psychiatric disorders during the premenstrual phase. We describe three patients with a history of mood swings associated with menstruation in whom major affective disorders developed, necessitating intensive psychiatric treatment or admission to hospital. Among women who manifest menstrual mood changes, manic-depressive illness may develop only in a subgroup with genetic predisposition. In such cases the possibility of postpartum mania or depression should be kept in mind in follow- up. Department of Psychiatry McGill University Montreal PQ. Meehan E MacRae K Legal implications of premenstrual syndrome: a Canadian perspective. CAN MED ASSOC J 1986 Sep 15; 135(6):601-8 A summary of the symptoms, prevalence and history of premenstrual syndrome (PMS) is presented. The legal implications of PMS, particularly its use as a defence in criminal prosecutions and as an implicit factor in specific offences, are discussed by means of an analysis of Canadian legal cases, with reference to those in England and the United States. The authors offer suggestions on how physicians can make use of PMS in a courtroom more reliable. They conclude that PMS is unlikely to become a substantive criminal defence until the medical community more fully recognizes its significance. Although the role of PMS as a mitigating factor in sentencing may be illogical, the courts now recognize the syndrome in a legally and practically important manner. Faculty of Law Common Law Section University of Ottawa Ont. *****CLINICAL ENDOCRINOLOGY (OXF)***** Andersch B Abrahamsson L Wendestam C Ohman R Hahn L Hormone profile in premenstrual tension: effects of bromocriptine and diuretics. CLIN ENDOCRINOL (OXF) 1979 Dec; 11(6):657-64 Plasma levels of prolactin, FSH, LH, progesterone and 17-beta- oestradiol in twenty women with premenstrual tension were compared with those in twenty controls. The former group was studied also during treatment with bromocriptine. The mean prolactin level in the PMT group was lower in the follicular phase than in the luteal phase (P less than 0.01), but there was no difference between the PMT and control group in the luteal phase. No differences were found between the controls and the PMT group in FSH,LH, 17-beta-oestradiol and progesterone levels in the luteal phase. Bromocriptine suppressed prolactin concentrations (P less than 0.01), but had no effect on the FSH, LH, 17-B-oestradiol or progesterone levels. *****CLINICAL OBSTETRICS AND GYNECOLOGY***** Maxson WS The use of progesterone in the treatment of PMS. CLIN OBSTET GYNECOL 1987 Jun; 30(2):465-77 Northwest Center for Infertility and Reproductive Endocrinology Margate FL 33063. Budoff PW Use of prostaglandin inhibitors in the treatment of PMS. CLIN OBSTET GYNECOL 1987 Jun; 30(2):453-64 Women's Medical Center Bethpage New York. Massil HY OBrien PM Approach to the management of premenstrual syndrome. CLIN OBSTET GYNECOL 1987 Jun; 30(2):443-52 Department of Obstetrics and Gynecology Royal Free Hospital London England. Kathol RG Evaluation of psychiatric symptoms in patients presenting with symptoms of premenstrual tension syndrome. CLIN OBSTET GYNECOL 1987 Jun; 30(2):408-16 The principal psychiatric syndrome seen in patients with premenstrual tension syndrome is depressive disorder. Questions that should be used to evaluate depression are reviewed and the addition of structured questionnaires for the depressive symptoms is not considered useful in this assessment. Other conditions that may or may not be related to the premenstrual period include psychosis (especially depression and mania), alcoholism, anxiety, and bulimia. Brief questioning concerning these conditions can be performed relatively quickly during the clinical evaluation. Second-source information should be obtained when at all possible. If treatable psychiatric illness is identified in those with premenstrual tension, it should be treated as if the psychiatric syndrome alone were present. There is no indication, however, that such treatment will alter the course of the premenstrual condition should it be present as well. Department of Internal Medicine University of Iowa Hospitals and Clinics Iowa City 52242. Keye WR Jr General evaluation of premenstrual symptoms. CLIN OBSTET GYNECOL 1987 Jun; 30(2):396-407 Department of Obstetrics and Gynecology University of Utah School of Medicine Salt Lake City 84132. Roy-Byrne PP Hoban MC Rubinow DR The relationship of menstrually related mood disorders to psychiatric disorders. CLIN OBSTET GYNECOL 1987 Jun; 30(2):386-95 Department of Psychiatry and Behavioral Sciences University of Washington Seattle 98195. Strickler RC Endocrine hypotheses for the etiology of premenstrual syndrome. CLIN OBSTET GYNECOL 1987 Jun; 30(2):377-85 Washington University School of Medicine Jewish Hospital of St. Louis MO 63110. Johnson SR The epidemiology and social impact of premenstrual symptoms. CLIN OBSTET GYNECOL 1987 Jun; 30(2):367-76 University of Iowa College of Medicine Iowa City 52242. Premenstrual syndrome. CLIN OBSTET GYNECOL 1987 Jun; 30(2):365-480 *****EMERGENCY MEDICINE CLINICS OF NORTH AMERICA***** Shapiro AG Emergency treatment of menstrual disorders in a nonpregnant woman. EMERG MED CLIN NORTH AM 1987 Aug; 5(3):559-68 Women who present to the Emergency room with menstrual-related problems are a common occurrence. In this article, we will concern ourselves with common problems that the nonpregnant woman in the reproductive years may present to the emergency room, including symptoms such as vaginal bleeding, painful menses, or premenstrual syndrome. Although the treatment within the emergency room is temporizing in nature, to better understand these problems and their appropriate management, these areas will be discussed as to their etiology, treatment, and prognosis. Department of Obstetrics/Gynecology Mount Sinai Medical Center of Greater Miami Florida. *****INTERNATIONAL JOURNAL OF FERTILITY***** Keye WR Jr Trunnell EP A biopsychosocial model of premenstrual syndrome. INT J FERTIL 1986 Sep-Oct; 31(4):259-62 The authors describe the application of a biopsychosocial model to premenstrual syndrome. In this model one assumes that premenstrual syndrome is the result of an interaction between biologic, psychologic, and social factors. A six-point approach to the evaluation of women with multiple premenstrual symptoms is also presented. Finally, the benefits of this model for the clinician and investigator are reviewed. Department of Obstetrics and Gynecology University of Utah Health Sciences Center Salt Lake City. *****JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY***** Conrad CD Hamilton JA Recurrent premenstrual decline in serum lithium concentration: clinical correlates and treatment implications. J AM ACAD CHILD PSYCHIATRY 1986 Nov; 25(6):852-3 *****JOURNAL OF CLINICAL PSYCHIATRY***** Chandraiah S PMS and rapid-cycling BAD [letter] J CLIN PSYCHIATRY 1987 Jul; 48(7):300-1 Price WA DiMarzio L Premenstrual tension syndrome in rapid-cycling bipolar affective disorder. J CLIN PSYCHIATRY 1986 Aug; 47(8):415-7 Premenstrual tension syndrome (PMS) and rapid-cycling bipolar affective disorder have similarities of symptoms, cyclical mood swings, and putative neurotransmitter dysfunction. The possible relationship between these disorders was assessed by evaluating 25 patients with rapid-cycling disorders and 25 normal controls for PMS symptoms. Patients with rapid-cycling affective disorder had an increased tendency to have more severe forms of PMS. In addition, patients with rapid-cycling disorders and more severe forms of PMS tended to cycle more frequently. The significance of this finding and its clinical implications are discussed. Northeastern Ohio Universities College of Medicine Price WA Giannini AJ Verapamil in the treatment of premenstrual syndrome: case report. J CLIN PSYCHIATRY 1986 Apr; 47(4):213-4 A woman with a long history of premenstrual tension syndrome (PMS) received verapamil for treatment of mitral valve prolapse. Associated with verapamil therapy was a decreased severity in many symptoms of PMS, including agitation, depression, emotional outbursts, and irritability. A possible mechanism is discussed. University of Pittsburgh Price WA Giannini AJ Antidepressant effects of estrogen [letter] J CLIN PSYCHIATRY 1985 Nov; 46(11):506 Giannini AJ Price WA Loiselle RH Giannini MC Hyperphagia in premenstrual tension syndrome. J CLIN PSYCHIATRY 1985 Oct; 46(10):436-8 The relationship between premenstrual tension syndrome and dietary intake was studied in a population of 20 young adult women. Caloric intake was measured during the 10 days preceding and following the menstrual cycle. Those women with more severe symptoms recorded a greater increase in caloric intake. Caloric intake during the premenstrual period also increased with age. It is hypothesized that this caloric intake may be due to increased beta-endorphin levels. *****JOURNAL OF FAMILY PRACTICE***** Friedman D Premenstrual syndrome. J FAM PRACT 1984 Nov; 19(5):669-71, 674-5, 678 Symptoms related to the premenstrual syndrome (PMS) are experienced by a large segment of the susceptible population. Its nature and the extent to which it is a problem are not well delineated and are subjects of significant controversy. Its etiology is uncertain. Cortical centers and neurotransmitters appear to play an important role. Its influence on the expression of other diseases and their influence on its presence or its severity have received insufficient study. Various approaches to therapy are commonly used, including birth control pills, diuretics, minor tranquilizers, and bromocriptine, but no single drug therapy is consistently effective. A strong placebo effect has been demonstrated with all medications that have been used. *****JOURNAL OF NERVOUS AND MENTAL DISEASE***** Stout AL Steege JF Blazer DG George LK Comparison of lifetime psychiatric diagnoses in Premenstrual Syndrome Clinic and community samples. J NERV MENT DIS 1986 Sep; 174(9):517-22 The purpose of this investigation was to obtain information about lifetime psychiatric diagnoses of women seeking treatment for premenstrual syndrome. The National Institute for Mental Health Diagnostic Interview Schedule (DIS) was administered to 223 women attending a premenstrual syndrome clinic. Rates of symptoms and psychiatric disorders were then compared with DIS data collected from an Epidemiologic Catchment Area (ECA) program community sample of 923 women in the same age group from the same geographic location. Women in the Premenstrual Syndrome Clinic sample met DIS/DSM-III criteria for dysthymia, phobia, obsessive-compulsive disorder, alcohol abuse/dependence, and drug abuse/dependence with a greater frequency than did women from the community sample. There appears to be much overlap between the symptoms for which women seek help from a specialty premenstrual syndrome clinic and symptoms related to several specific affective, anxiety, and substance abuse disorders. Further investigation is needed to determine whether premenstrual syndrome is strongly associated with DSM-III psychiatric diagnoses or whether current psychiatric classification systems are inadequate for differentiation. Duke University Medical Center Durham North Carolina 27710 *****JOURNAL OF REPRODUCTIVE MEDICINE***** Lyon KE Lyon MA The premenstrual syndrome. A survey of current treatment practices. J REPROD MED 1984 Oct; 29(10):705-11 Interest in the premenstrual syndrome (PMS) has increased rapidly in both the lay and professional communities during the past few years. Research on the causes, diagnosis and treatment of the disorder continues to expand. An area that has received little attention, however, is the current treatment practices of physicians who recognize PMS as a treatable disorder. Our study was a survey of 502 physicians from the United States and Canada regarding diagnostic and treatment services provided to their PMS patients. Descriptive results of the survey, as well as breakdowns by medical specialty and region, were obtained. The results have implications for current practice and future research. Department of Psychology University of Wisconsin River Falls Chakmakjian ZH A critical assessment of therapy for the premenstrual tension syndrome. J REPROD MED 1983 Aug; 28(8):532-8 Various kinds of therapy have been used for the symptoms of premenstrual tension (PMT): sex steroid hormones, vitamins, prolactin inhibitors, hormones and factors associated with fluid retention and psychiatric/behavioral regimens. Clinical trials with natural progesterone, synthetic progestogens, androgens, estrogens, contraceptive pills, pyridoxine (vitamin B6), dopamine agonists, diuretics, psychoactive drugs and psychotherapy have given conflicting results. All these treatments are based on some underlying notion of etiology. Since the etiology of PMT is still obscure, it is not surprising that as yet there is no single treatment that is universally accepted as effective. It is essential that future trials be well controlled and double blind and that they include large numbers of participants keeping daily records of symptoms during the control and experimental cycles. Shangold MM Drug therapy for the premenstrual syndrome. J REPROD MED 1983 Aug; 28(8):525-6 The premenstrual syndrome is diagnosed historically, with symptoms recorded meticulously on a menstrual calendar. No physical findings or laboratory tests are helpful. Although this entity remains poorly understood, drug therapy is often indicated and remains empiric at present. Abplanalp JM Psychologic components of the premenstrual syndrome. Evaluating the research and choosing the treatment. J REPROD MED 1983 Aug; 28(8):517-24 Methodologic problems that impede the evaluation of the psychologic components of the premenstrual syndrome (PMS) include: (1) the lack of a consensus on the definition of PMS (resulting in significant variations between studies with respect to severity, timing and course of the symptoms); (2) the use of retrospective, rather than prospective, methods of data collection (which increases the likelihood of culturally based response bias); (3) sampling errors; (4) failure to assess and/or control for experimental bias introduced as a function of the subject's perception of the purpose of the evaluation; and (5) inadequate attention paid to timing within the cycle of data collection. Treatment of the psychologic components of PMS requires an individualized approach. Given our current knowledge of this syndrome (or syndromes), there is no way to predict with a high level of assurance which patients will benefit most from behavioral, pharmacologic, nutritional or hormonal therapy. The most urgent priorities in future research on PMS treatment are controls for placebo effects and more sophisticated approaches to sample selection. Horrobin DF The role of essential fatty acids and prostaglandins in the premenstrual syndrome. J REPROD MED 1983 Jul; 28(7):465-8 Many of the features of the premenstrual syndrome are similar to the effects produced by the injection of prolactin. Some women with the premenstrual syndrome have elevated prolactin levels, but in most the prolactin concentrations are normal. It is possible that women with the syndrome are abnormally sensitive to normal amounts of prolactin. There is evidence that prostaglandin E1, derived from dietary essential fatty acids, is able to attenuate the biologic actions of prolactin and that in the absence of prostaglandin E1 prolactin has exaggerated effects. Attempts were made, therefore, to treat women who had the premenstrual syndrome with gamma-linolenic acid, an essential fatty acid precursor of prostaglandin E1. Gamma-linolenic acid is found in human, but not cows', milk and in evening primrose oil, the preparation used in these studies. Three double-blind, placebo-controlled studies, one large open study on women who had failed other kinds of therapy for the premenstrual syndrome and one large open study on new patients all demonstrated that evening primrose oil is a highly effective treatment for the depression and irritability, the breast pain and tenderness, and the fluid retention associated with the premenstrual syndrome. Nutrients known to increase the conversion of essential fatty acids to prostaglandin E1 include magnesium, pyridoxine, zinc, niacin and ascorbic acid. The clinical success obtained with some of these nutrients may in part relate to their effects on essential fatty acid metabolism. Abraham GE Nutritional factors in the etiology of the premenstrual tension syndromes. J REPROD MED 1983 Jul; 28(7):446-64 The premenstrual symptom complex many women experience in a moderate to severe form can be divided into four subgroups. Because there is more than one syndrome and nervous tension is one of the most common symptoms, the term premenstrual tension syndromes (PMTS) is used. The most common subgroup, PMT-A, consists of premenstrual anxiety, irritability and nervous tension, sometimes expressed in behavior patterns detrimental to self, family and society. Elevated blood estrogen and low progesterone have been observed in this subgroup. Administration of vitamin B6 at doses of 200-800 mg/day reduces blood estrogen, increases progesterone and results in improved symptoms under double-blind conditions. Women in this subgroup consume an excessive amount of dairy products and refined sugar, and progesterone may be of value in them. The second-most-common subgroup, PMT-H, is associated with symptoms of water and salt retention, abdominal bloating, mastalgia and weight gain. The severe form of PMT-H is associated with elevated serum aldosterone. Vitamin B6 at high dosage suppresses aldosterone and results in diuresis and clinical improvement. Vitamin E helps the breast symptoms. Methylxanthines and nicotine should be curtailed and sodium limited to 3 gm/day. PMT-C is characterized by premenstrual craving for sweets, increased appetite and indulgence in eating refined sugar followed by palpitation, fatigue, fainting spells, headache and sometimes the shakes. PMT-C patients have increased carbohydrate tolerance and low red-cell magnesium. Adequate magnesium replacement results in improved glucose tolerance tests and decreased PMT-C symptoms. Deficiency of the prostaglandin PGE1 may also be involved in PMT-C. PMT-D is the least common but most dangerous because suicide is most frequent in this subgroup. The symptoms are depression, withdrawal, insomnia, forgetfulness and confusion. In ten PMT-D patients the mean blood estrogen was lower and the mean blood progesterone higher than normal during the midluteal phase. Elevated adrenal androgens are observed in some hirsute PMT-D patients. Two PMT-D patients with normal blood progesterone and estrogens had high lead levels in hair tissue and chronic lead intoxication. This subgroups needs careful medical attention when the symptoms are severe. Therapy should be individualized according to the results of the evaluation. Hargrove JT Abraham GE The ubiquitousness of premenstrual tension in gynecologic practice. J REPROD MED 1983 Jul; 28(7):435-7 One hundred thirty-seven premenopausal women with premenstrual tension underwent laparoscopy for bleeding, pain and/or infertility. Endometriosis was the associated gynecologic disease observed most frequently (66 patients). Other associated disorders were primary dysmenorrhea (31), poststerilization syndrome (24), chronic pelvic inflammatory disease (8) and leiomyoma uteri (8). Screening for prolactin and thyroid-stimulating hormone in patients with galactorrhea (74) revealed one patient with pituitary microadenoma and two with primary hypothyroidism. The midluteal progesterone levels were significantly decreased, whereas the midluteal estradiol 17 beta levels were significantly elevated. Because of the frequent association of premenstrual tension with other gynecologic diseases, screening for premenstrual tension in all premenopausal women is recommended. Heinrichs WL Adamson GD A practical approach to the patient with dysmenorrhea. J REPROD MED 1980 Oct; 25(4 Suppl):236-42 Pelvic pain associated with the menses may be a result of physiologic problems, premenstrual tension syndrome, primary dysmenorrhea or secondary dysmenorrhea. All of these conditions may be caused by both physiologic and psychologic factors. An accurate diagnosis requies a complete history and physical examination and astute assessment of predisposing or aggravating conditions. Diagnosis has been improved through the use of laparoscopy, hysteroscopy, hysterosalpingography and dilatation and curettage. Treatment has been revolutionized with the use of oral contraceptives and prostaglandin synthesis inhibitors. These diagnostic and therapeutic advances now enable the sympathetic physician to effectively evaluate and treat almost all patients with menstrually related pelvic pain. When all of these approaches fail, the physician should consider psychiatric consultation or referral to pain clinic or gynecologist with special interest in this field. Chihal HJ Indications for drug therapy in premenstrual syndrome patients. J REPROD MED 1987 Jun; 32(6):449-52 Women with mild to moderate premenstrual syndrome (PMS) should have their symptoms controlled with conservative therapy, including diet, exercise, education and nutritional supplementation. Those patients with moderate to severe PMS whose condition cannot be controlled in this conservative fashion should undergo pharmacologic trials. Recent studies of progesterone supplementation showed no improvement when it was compared to placebo; the one exception was the use of oral micronized progesterone one therapy at a level of 300 mg/day, but the study remains to be repeated by other investigators. The most logical therapy at present is suppression of ovulation with a short-term trial of danazol, perhaps followed by long-term suppression with estrogen implants or depomedroxyprogesterone acetate. Surgical ovariectomy is warranted in a very small number of cases. Prostaglandin inhibitors are effective for the physical complaints that may be associated with PMS. Some antihypertensive agents, such as clonidine and verapamil, which are also antimania drugs, may have a place in the treatment of PMS. Texas Endocrine and Fertility Institute Carrollton 75010. Stewart A Clinical and biochemical effects of nutritional supplementation on the premenstrual syndrome. J REPROD MED 1987 Jun; 32(6):435-41 Many different treatments have been suggested for the premenstrual syndrome (PMS), including such nutritional supplements as vitamins, minerals and essential fatty acids. There is little agreement about the causes or treatments of the syndrome. The effect of a nutritional supplement, at high and low dosage, on premenstrual symptoms was assessed in a double-blind, placebo-controlled study. Also, the nutritional state of 11 women with PMS was evaluated. There was laboratory evidence of significant deficiencies in vitamin B6 and magnesium; other deficiencies occurred frequently, also. The multivitamin/multimineral supplement was shown to correct some of these deficiencies and, at the appropriate dosage, to improve the symptoms of premenstrual tension. Pre-Menstrual Tension Advisory Service Hove England. Vellacott ID OBrien PM Effect of spironolactone on premenstrual syndrome symptoms. J REPROD MED 1987 Jun; 32(6):429-34 The premenstrual syndrome (PMS) has long been considered one in which fluid retention plays an important role. Detailed studies, however, have failed to reveal good evidence for this assumption, and investigations of weight change and of sodium and water balance have yielded contradictory results. Even so, a number of the etiologic theories and treatment regimens are based on this premise. Many of the endocrine theories depend on the endocrine effect on water balance to explain the mechanism, and the treatment often proposed involves salt and water restriction and the liberal use of diuretics. There is no justification for this advice except for a few well- conducted studies that showed the benefits of diuretic therapy. The evidence from these studies suggests that diuretics, especially spironolactone, have a particular role in the management of the PMS symptoms of bloatedness and abdominal distension despite the fact that the underlying water retention theory remains in doubt. An improvement in the various psychologic symptoms of PMS has also been reported. Department of Obstetrics and Gynecology Royal Free Hospital London England. Abraham GE Rumley RE Role of nutrition in managing the premenstrual tension syndromes. J REPROD MED 1987 Jun; 32(6):405-22 The clinical, biochemical and endocrine effects of a total dietary program were evaluated in patients with the premenstrual tension syndromes (PMTS). The program consisted of dietary guidelines and nutritional supplementation. Open trials suggested that an initial dosage of the supplement consisting of six tablets daily gave the best symptomatic relief during the first three to six months. Double- blind studies confirmed that a daily average of six tablets decreased PMTS symptom scores to significantly lower levels than did the placebo. A significantly higher percentage of PMTS patients reported feeling better on the dietary program than did those on the placebo. Although significant changes were observed in some liver function tests, the values were within the normal ranges. The dietary program, implemented for three to six months, decreased serum estradiol 17- beta and increased serum progesterone levels during the midluteal phase in PMTS patients. Nonresponders using the program should be reevaluated and treated according to the results of the reevaluation and the PMTS symptoms. Optimox Inc. Torrance California. London RS Murphy L Kitlowski KE Reynolds MA Efficacy of alpha-tocopherol in the treatment of the premenstrual syndrome. J REPROD MED 1987 Jun; 32(6):400-4 In a preliminary study, alpha-tocopherol supplementation was effective in reducing specific symptoms of the premenstrual syndrome (PMS). To confirm these findings, we performed a randomized, double- blind study using d,alpha-tocopherol and placebo in a carefully screened population of women with PMS. Standardized PMS questionnaires were administered in the luteal phase of the menstrual cycle to all subjects, before and after daily treatment with 400 IU d,alpha-tocopherol or placebo for three cycles. Of the 46 subjects enrolled, 41 completed the clinical trial. A significant improvement in certain affective and physical symptoms was noted in subjects treated with d,alpha-tocopherol. Division of Reproductive Medicine North Charles Hospital Baltimore MD 21218. Siegel JP Myers BJ Dineen MK Premenstrual tension syndrome symptom clusters. Statistical evaluation of the subsyndromes. J REPROD MED 1987 Jun; 32(6):395-9 Premenstrual symptoms were evaluated in a group of women with severe premenstrual tension syndrome. Factor analysis was performed in order to establish the nature of symptom clusters in this sample. Similar to clinical observations reported on before, the results revealed two distinct clusters of emotional/behavioral symptoms and two of physical symptoms. Jane Addams College of Social Work University of Illinois Chicago 60680. Rubinow DR Schmidt PJ Mood disorders and the menstrual cycle. J REPROD MED 1987 Jun; 32(6):389-94 Since the premenstrual syndromes characteristically present with mood, cognitive and behavioral disturbances, a special relationship between psychiatric disorders and the premenstrual syndromes has been postulated. With a series of questions we attempted to clarify the nature of the relationship between the menstrual cycle and mood and behavior, and we specifically addressed the similarities and differences between the premenstrual syndromes and formal psychiatric disorders. The premenstrual syndromes may serve as a biobehavioral model for the investigation of the biologic contributors to mood state regulation. Unit on Peptide Studies National Institute of Mental Health Bethesda MD 20205. The premenstrual tension syndromes: an update. J REPROD MED 1987 Jun; 32(6):387-452 Friedman D Jaffe A Influence of life-style on the premenstrual syndrome. Analysis of a questionnaire survey. J REPROD MED 1985 Oct; 30(10):715-9 The premenstrual syndrome (PMS) is influenced by parameters of life- style. An analysis was done of 384 questionnaires completed by women with a wide variety of life-styles. Four measures of PMS symptomatology were developed to assess the areas of edema, autonomic responses, affect and coping mechanisms. Significance associations were found between PMS symptomatology and regularity of periods, occupational level and educational attainment. Housewives were found to report the highest levels of symptom expression. Visits to physicians due to PMS were found to be higher than is usually reported in the medical literature. Department of Family Medicine State University of New York at Stony Brook 11794 *****LANCET***** Dalton K Cyclical criminal acts in premenstrual syndrome. LANCET 1980 Nov 15; 2(8203):1070-1 3 women successfully pleaded diminished responsibility or mitigation due to premenstrual syndrome in crimes of manslaughter, arson, and assault. All had long histories of repeated misdemeanours, which continued while in prison. Police and prison records confirmed the diagnosis of premenstrual syndrome. The women were successfully treated with progesterone, and their behaviour returned to normal. Severino SK Mortati SG A sexist diagnosis? LANCET 1986 Dec 13; 2(8520):1386 Department of Psychiatry Cornell University Medical College New York Hospital White Plains 10605. *****MEDICAL JOURNAL OF AUSTRALIA***** Dennerstein L Judd F Davies B Psychosis and the menstrual cycle. MED J AUST 1983 May 28; 1(11):524-6 A case of a puerperal psychosis in a 26-year-old woman who had a strong family history of schizophrenia is reported. Her symptoms resolved with chlorpromazine and electroconvulsive therapy, but recurred each month just before the onset of menses. The cyclical recurrence of symptoms was prevented by therapy with danazol, a synthetic steroid which inhibits ovulation and may influence several levels of the reproductive control mechanism from the hypothalamus to the uterus. This therapy may be helpful for other women who suffer from recurrence of severe psychiatric disorders in close association with the menstrual cycle. 79134531 Graham JJ Harding PE Wise PH Berriman H Prolactin suppression in the treatment of premenstrual syndrome. MED J AUST 1978 Nov 4; 2(3 Suppl):18-20 Abnormal secretion of prolactin is amongst the many disorders of hormone secretion which have been proposed as potential causes for the common syndrome of premenstrual tension. Eight women suffering from this disorder participated in a five-month double-blind crossover trial of bromocriptine (5 mg per day) given in the luteal phase of the cycle. Significant improvement in most symptoms occurred during active as opposed to placebo therapy, together with objective evidence of a decrease in premenstrual weight gain and breast enlargement. This corresponds with the results of other studies which used bromocriptine in this dosage. The effect may be mediated by suppression of prolactin secretion, but could equally be a direct effect of bromocriptine. Hart WG Coleman GJ Russell JW Psychiatric screening in the premenstrual syndrome. MED J AUST 1987 May 18; 146(10):518-9, 522 Prospective daily ratings of premenstrual symptomatology were obtained from 40 women for one full menstrual cycle. Nineteen of these women were complaining of suffering from a premenstrual syndrome. The General Health Questionnaire (GHQ) was administered in the mid-follicular and late luteal phases of the cycle. Women who were complaining of the premenstrual syndrome showed significant premenstrual increases in premenstrual symptoms, of a magnitude that was significantly greater than those of control subjects. The GHQ scores of the women who were complaining of premenstrual syndrome were significantly higher than those of the control subjects in both the follicular and luteal phases of the cycle. The mean GHQ score of the group with premenstrual syndrome was significantly elevated above the published normal value. Fifty-six per cent of those who complained of premenstrual syndrome had follicular GHQ scores which were higher than the recommended threshold for clinical psychiatric disturbance. Only 10.5% of the control group were above this threshold. General Health Questionnaire scores were stable across phases of the cycle and were correlated to the severity of symptoms of premenstrual syndrome. Premenstrual Moos Menstrual Distress Questionnaire (MDQ) scores were related strongly to follicular MDQ scores. A high proportion of women who complain of premenstrual syndrome show evidence of a more general psychiatric problem which should be evaluated before therapy. Health Psychology Centre School of Behavioural Sciences Lincoln Institute of Health Sciences Carlton VIC. Russell J Johnson GF Premenstrual syndrome [editorial] MED J AUST 1987 May 18; 146(10):510-1 Hart WG Russell JW A prospective comparison study of premenstrual symptoms. MED J AUST 1986 Apr 28; 144(9):466-8 A study in which two groups of women were compared prospectively has been carried out. One group (n = 31) complained of premenstrual syndrome (PMS) whereas the other group (n = 12) denied suffering from PMS. It was found that premenstrual symptoms increased significantly in women who complained of PMS although some symptoms (irritability, abdominal swelling) increased significantly in the other group as well. The group that complained of PMS showed significantly greater premenstrual increases in some symptoms than did the comparison group, but not in anxiety, irritability, tension or breast tenderness. In the late follicular phase statistically significant baseline differences occurred between the two groups in depression, anxiety, tension and irritability. Significant correlations between baseline and premenstrual scores in the PMS group were found for most of the symptoms that were studied, particularly for tension, anxiety, sleeplessness and depression. These results suggest that women who complain of premenstrual syndrome may require therapy for their generally higher levels of anxiety and depression throughout the entire menstrual cycle rather than for the premenstrual exacerbation alone. School of Behavioural Sciences Lincoln Institute of Health Sciences Carlton, Vic *****NURSING RESEARCH***** Woods NF Most A Longenecker GD Major life events, daily stressors, and perimenstrual symptoms. NURS RES 1985 Sep-Oct; 34(5):263-7 Major life events and daily stressors have been associated with women's experience of perimenstrual symptoms (PS). The purpose of this study was to determine the relationship of major life events and daily stressors to PS. Seventy-four women between 18 and 35 years of age kept daily recordings of stressors and symptoms for 2 months after which they completed the Schedule of Recent Events and the Moos Menstrual Distress Questionnaire (MDQ). Major life events were associated with PS reports on the MDQ but not with symptoms reported in the daily health diary. Daily stressors were more influential in perimenstrual symptoms than the cumulation of major life events. Moreover, a generally stressful life context was more influential in the experience of perimenstrual symptoms than episodes of stressful experiences during a particular menstrual cycle phase. *****OBSTETRICS AND GYNECOLOGY***** Ylostalo P Kauppila A Puolakka J Ronnberg L Janne O Bromocriptine and norethisterone in the treatment of premenstrual syndrome. OBSTET GYNECOL 1982 Mar; 59(3):292-8 Thirty-six women suffering from premenstrual syndrome were treated with bromocriptine or norethisterone in a randomized placebo- controlled double-blind study. Bromocriptine decreased breast engorgement and irritability (P less than .01) and also decreased the total score of all symptoms (P less than .05). Weight gain during the luteal phase was smaller (P less than .05) during bromocriptine than during placebo treatment. Norethisterone treatment alleviated (P less than .05) breast tenderness. Changes in hormonal parameters and liver function tests during bromocriptine treatment were minimal, whereas norethisterone decreased serum levels of luteinizing hormone (P less than .01), follicle-stimulating hormone (P less than .001), and progesterone (P less than .05), while increasing the serum level of prolactin (P less than .01) and gamma-glutamyltranspeptidase activity (P less than .05). Serum levels of cholic acid and chenodeoxycholic acid remained unchanged during both therapies. Bromocriptine treatment brought about side effects in 6 and norethisterone in 3 women. At the doses used, bromocriptine appears more efficient than norethisterone with regard to premenstrual symptoms, although norethisterone is better tolerated. Mabray CR Burditt ML Martin TL Jaynes CR Hayes JR Treatment of common gynecologic-endocrinologic symptoms by allergy management procedures. OBSTET GYNECOL 1982 May; 59(5):560-4 The technique of managing allergies by optimum-dose (provocative neutralization) testing and treatment using aqueous progesterone has been studied in 132 women having progesterone-related symptoms due to the menstrual cycle, pregnancy, or exogenous hormone administration. When extremely small doses of progesterone (0.0016 mg or below, up to maximum of 2.5 mg) were administered following determination of specific dose requirement by skin testing, startlingly rapid and effective clearing of symptoms was observed. With these individualized doses, symptoms cleared completely or almost completely within 30 minutes in the majority of patients. A single- blind technique was employed to rule out placebo effect. Some common problems found to respond well to the procedure were nausea and vomiting during pregnancy (100%), premenstrual syndrome (96%), and dysmenorrhea (84%). Elsner CW Buster JE Schindler RA Nessim SA Abraham GE Bromocriptine in the treatment of premenstrual tension syndrome. OBSTET GYNECOL 1980 Dec; 56(6):723-6 Twenty-four women with regular cycles who reported moderate to severe premenstrual tension participated in a double-blind study to test the effectiveness of CB154 on the control of their symptoms. Symptoms were scored daily and were further evaluated objectively twice monthly by physical examination. Control cycle follicular/luteal delta weights were not different statistically from a 0 change (P > .10), despite long-standing symptoms of bloating, swelling, and reported weight gain. CB154 treatment resulted in statistically significant improvement in daily ratings of breast tenderness (P < .005), bloating (P < .02), and depression (P < .05). Significant placebo effects observed for several other symptoms emphasize the psychologic component of this condition as well as the need for caution in the interpretation of any uncontrolled trials for therapies thought effective in the treatment of this disorder. Rapkin AJ Edelmuth E Chang LC Reading AE McGuire MT Su TP Whole-blood serotonin in premenstrual syndrome. OBSTET GYNECOL 1987 Oct; 70(4):533-7 Whole-blood serotonin levels in 14 subjects with well documented premenstrual syndrome and 13 age-matched controls were compared. Serotonin levels of premenstrual syndrome subjects were significantly lower during the last ten days of the menstrual cycle. No significant differences were noted in levels of serum estradiol and progesterone. Decreased serotonin is known to be associated with depression in humans, and nonhuman primates have exhibited abnormal behavioral profiles when given serotonin antagonists. The present observation suggests that the physiologic basis of premenstrual syndrome involves an alteration in serotonin metabolism. Department of Obstetrics and Gynecology University of California Los Angeles. Kendall KE Schnurr PP The effects of vitamin B6 supplementation on premenstrual symptoms. OBSTET GYNECOL 1987 Aug; 70(2):145-9 A double-blind controlled study of the effects of vitamin B6 supplementation on premenstrual symptoms was conducted. Fifty-five women who reported moderate to severe premenstrual mood changes participated in the study. Symptoms were monitored prospectively through daily home record-keeping over a one-month baseline period followed by two months of treatment. Subjects were randomly assigned to receive daily supplements of 150 mg of vitamin B6 or placebo over the entire two-month treatment period. Analysis of covariance suggested that even though vitamin B6 may improve premenstrual symptoms related to autonomic reactions (eg, dizziness and vomiting) and behavioral changes (eg, poor performance and decreased social activities), a significant amount of physical and affective symptomatology remained during the premenstrual phase. In light of recently reported, potentially toxic effects of low doses of vitamin B6, our results call for caution in using this therapy for premenstrual symptoms. Department of Psychology University of Massachusetts Amherst. Smith S Rinehart JS Ruddock VE Schiff I Treatment of premenstrual syndrome with alprazolam: results of a double-blind, placebo-controlled, randomized crossover clinical trial. OBSTET GYNECOL 1987 Jul; 70(1):37-43 A double-blind, placebo-controlled, randomized multiple crossover study was designed to determine the effectiveness of alprazolam in the treatment of premenstrual syndrome. Patients maintained daily diaries of 22 premenstrual symptoms for one pretreatment control cycle and four treatment cycles. Alprazolam 0.25 mg or placebo was administered three times daily from cycle day 20 until the second day of menstruation, at which time the dosage was tapered by one tablet per day to minimize withdrawal effects. The results of the clinical trial indicate that alprazolam is significantly more effective than placebo in relieving the severity of premenstrual nervous tension, mood swings, irritability, anxiety, depression, fatigue, forgetfulness, crying, cravings for sweets, abdominal bloating, abdominal cramps, and headache. The low incidence of side effects makes alprazolam an acceptable treatment for premenstrual syndrome for those women unresponsive to other therapies. Department of Obstetrics and Gynecology Brigham and Women's Hospital Boston Massachusetts. Sarno AP Jr Miller EJ Jr Lundblad EG Premenstrual syndrome: beneficial effects of periodic, low-dose danazol. OBSTET GYNECOL 1987 Jul; 70(1):33-6 Danazol (200 mg/day) or placebo was administered to patients with premenstrual syndrome from the onset of symptoms until the onset of menses, for two cycles each, in a prospective, double-blind, crossover design. Eleven of 14 patients improved on danazol. The symptom scores with danazol were significantly lower than those with placebo (P less than .035). No side effects were reported from the medication. We conclude that danazol, given periodically and in a relatively low dose, appears to have a beneficial effect in the treatment of premenstrual syndrome. Department of Obstetrics and Gynecology Fitzsimons Army Medical Center Aurora Colorado. Freeman EW Sondheimer SJ Rickels K Medical and psychologic characteristics of women presenting with premenstrual symptoms [letter] OBSTET GYNECOL 1987 Jul; 70(1):142-3 Keye WR Jr Hammond DC Strong T Medical and psychologic characteristics of women presenting with premenstrual symptoms. OBSTET GYNECOL 1986 Nov; 68(5):634-7 To establish the necessary elements of a program of evaluation and treatment of premenstrual syndrome, the medical and psychologic characteristics of 68 consecutive women presenting because of premenstrual symptoms were determined and compared with those of a similar group of 34 women without premenstrual symptoms (control group). Women with premenstrual symptoms exhibited a significantly greater frequency of previously undetected medical, psychologic, and marital problems than did controls. These findings demonstrate the need for a multidisciplinary comprehensive program of evaluation and treatment of the medical, psychologic, and mental health of women who present because of moderate-to-severe premenstrual symptoms. Department of Obstetrics and Gynecology University of Utah Medical Center Salt Lake City. Mira M McNeil D Fraser IS Vizzard J Abraham S Mefenamic acid in the treatment of premenstrual syndrome. OBSTET GYNECOL 1986 Sep; 68(3):395-8 The use of mefenamic acid in the treatment of premenstrual syndrome (PMS) was investigated in 15 women over six menstrual cycles. A randomized, double-blind, cross-over, placebo-controlled design was used to overcome the methodologic criticisms of other medication trials in this condition. Mefenamic acid significantly improved many of the physical, mood, and performance symptoms associated with PMS. The physical symptoms that showed marked improvement were fatigue, headache, and general aches and pains (P less than .001). Most mood symptoms were improved, the most significant being freedom from mood swings (P less than .005). Department of Obstetrics & Gynaecology University of Sydney Australia *****POSTGRADUATE MEDICAL JOURNAL***** Day J Danazol and the premenstrual syndrome. POSTGRAD MED J 1979; 55 Suppl 5:87-9 Danazol as a powerful antigonadotrophin is a logical mode of treatment for patients with premenstrual symptoms. Its preliminary use in a dose 200-800 mg daily is reported. Two groups of patients were treated and of 12 patients with severe symptoms (Group I) six benefited from treatment. The second group (Group II) presenting as fresh cases were given 400 mg daily as the first or second choice of treatment. This group had a high drop out rate and any benefit from treatment was marred by the side effects. Danazol will continue to be used where the symptoms are resistant to other treatment, especially when breast tenderness is predominant. The dose should be the minimum required for relief of symptoms. *****SCIENCE***** 77215902 Ruble DN Premenstrual symptoms: a reinterpretation. SCIENCE 1977 Jul 15; 197(4300):291-2 Conclusions regarding the physiological basis and disruptive effects of premenstrual symptoms may be biased because of the reliance on self-report questionnaires as a source of data. In order to examine this possible bias, women's perceptions of their cycle phase were separated experimentally from actual cycle phase. Women who were led to believe that they were premenstrual reported experiencing a significantly higher degree of several physical symptoms, such as water retention, than did women who were led to believe they were intermenstrual. Thus, because of these psychosocial influences on symptom reports, it seems necessary to reexamine previous conclusions regarding the magnitude of menstrual-related changes as well as their physiolocical basis. Holden C Proposed new psychiatric diagnoses raise charges of gender bias [news] SCIENCE 1986 Jan 24; 231(4736):327-8 *** *** *****AAOHN JOURNAL***** Premenstrual syndrome: medical puzzle of the '80s. AAOHN J 1986 Feb; 34(2):98-9 *****ACTA PSYCHIATRICA SCANDINAVICA***** Hallman J Oreland L Edman G Schalling D Thrombocyte monoamine oxidase activity and personality traits in women with severe premenstrual syndrome. ACTA PSYCHIATR SCAND 1987 Sep; 76(3):225-34 Women with premenstrual syndrome (PMS) of such severity that they actively had sought medical attention for their symptoms were compared with healthy female students with regard to platelet MAO activity and temperamental correlates by means of the Karolinska Scales of Personality (KSP), scales from the Eysenck Personality Questionnaire (EPQ) and Eysenck's IVE inventory. The women with PMS were divided into two groups; irritability and depression as predominating symptom. No variation in platelet MAO was found during the menstrual cycle, either in patients or in controls. Both PMS groups had significantly lower platelet MAO activity than the controls. There was no difference between the two groups with PMS. Also with regard to personality traits there were considerable differences between the females with PMS and the controls. There were few differences between the two groups of PMS patients. Thus, the patients scored significantly higher as regards somatic anxiety, muscular tension, indirect aggression, verbal aggression and neuroticism and lower as regards socialization than the controls. Department of Psychiatry University of Uppsala Sweden. Hallman J The premenstrual syndrome--an equivalent of depression? ACTA PSYCHIATR SCAND 1986 Apr; 73(4):403-11 The prevalence and symptoms of premenstrual syndrome (PMS) were studied in a survey using a random selection of fertile women (n = 1,852). The prevalence of PMS was 72.8%. 7.5% of the women with PMS felt they needed to see a physician. The survey responses from this latter group were compared with the answers from the remaining women with PMS. The symptoms differ significantly in many respects between the groups. Women who want to see a physician report, to a greater extent, symptoms during the premenstrual period which are seen in depressive states. Oral contraceptives do not seem to affect premenstrual symptoms in this group. The results suggest that severe premenstrual symptoms of predominantly depressive nature are probably a manifestation of an underlying depressive disorder. Department of Psychiatry Uppsala University Akademiska sjukhuset, Sweden *****ADVANCES IN BIOCHEMICAL PSYCHOPHARMACOLOGY***** Rubinow DR Hoban MC Grover GN Menstrually-related mood disorders. ADV BIOCHEM PSYCHOPHARMACOL 1987; 43:335-46 Unit on Peptide Studies National Institute of Mental Health Bethesda Maryland 20892. *****ANNALS OF CLINICAL BIOCHEMISTRY***** Sherwood RA Rocks BF Stewart A Saxton RS Magnesium and the premenstrual syndrome. ANN CLIN BIOCHEM 1986 Nov; 23 ( Pt 6):667-70 Plasma and erythrocyte magnesium were measured in 105 patients with premenstrual syndrome (PMS) using a simple atomic absorption spectroscopy method. The erythrocyte magnesium concentration for the patients with PMS was significantly lower than that of a normal population. The plasma magnesium did not show this difference. The significance of this apparent cellular deficiency of magnesium is discussed. Biochemistry Department Royal Sussex County Hospital East Sussex UK. *****BRITISH JOURNAL OF CLINICAL PRACTICE***** Smallwood J Ah-Kye D Taylor I Vitamin B6 in the treatment of pre-menstrual mastalgia. BR J CLIN PRACT 1986 Dec; 40(12):532-3 *****CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE***** Halbreich U Endicott J Lesser J The clinical diagnosis and classification of premenstrual changes. CAN J PSYCHIATRY 1985 Nov; 30(7):489-97 Recent interest in premenstrual changes and increasing referrals for treatment when such is warranted, bring to focus the need for accurate definition of the problem and a reliable procedure for clinical and research assessments of premenstrual phenomena. A definition is suggested and the steps taken to establish the diagnosis of the various premenstrual subtypes are described. The suggested classification may contribute to differential treatment modalities for each subtype. Albert Einstein College of Medicine, NY Keye WR Jr Medical treatment of premenstrual syndrome. CAN J PSYCHIATRY 1985 Nov; 30(7):483-8 Treatment of Premenstrual Syndrome has been hampered by the ongoing confusion concerning the etiology of this disorder. Lack of universally accepted diagnostic criteria has been a major factor in the inconclusive and contradictory results of most studies of treatment. Medical treatments which have been used for Premenstrual Syndrome can be divided into three major groups: those that are designed to relieve specific symptoms without attempting to modify the underlying disease process; those that presumably correct what is hypothesized as being the underlying pathophysiology of the disorder; and those that alter the normal ovulatory menstrual cycle. This paper critically reviews a multitude of proposed treatments including psychoactive drugs, diet, exercise, vitamin supplements, hormones and surgery. There is no clear cut evidence of the effectiveness of any of these medical approaches. The emphasis on medical and drug therapies should not discourage physicians from evaluating the effects of psychotherapy on symptom amelioration. Department of Gynecology and Obstetrics College of Medicine University of Utah, Salt Lake City Clare AW Premenstrual syndrome: single or multiple causes? CAN J PSYCHIATRY 1985 Nov; 30(7):474-82 The numerous theories of causation of Premenstrual Syndrome have been reviewed. These range from biological to environmental hypotheses. As yet, no clear cut organic or psychological explanation has been found to explain this complicated syndrome. Findings to date suggest that this condition may be the final stage of multiple and interacting social, psychological and biological factors. St. Bartholomew's Hospital Medical College London England Rubinow DR Hoban C Roy-Byrne P Grover GN Post RM Premenstrual syndromes: past and future research strategies. CAN J PSYCHIATRY 1985 Nov; 30(7):469-73 Premenstrual Syndrome remains a poorly understood controversial disorder largely because of the errors in design found in research into this subject. The first task is to clearly define the entity to be studied. It is necessary to look at the nature, intensity and time of occurrence of symptoms in relation to menstruation. One must further differentiate the appearance of symptoms premenstrually from the premenstrual exacerbation of symptoms present throughout the menstrual cycle. Research has clearly shown the superiority of prospective versus retrospective data in establishing a linkage between symptoms and menstruation. Premenstrual Syndrome research offers a unique opportunity to study classical psychiatric disorders. A relationship appears to exist between this syndrome and major affective disorders. Studies of the appearance or exacerbation of mood disturbances in relation to the menstrual cycle may inform us about the development, course and vicissitudes of psychiatric illness. Biological Psychiatry Branch National Institute of Mental Health Bethesda, MD Kinch RA Robinson GE Premenstrual syndrome--current knowledge and new directions. CAN J PSYCHIATRY 1985 Nov; 30(7):467-8 *****CLINICAL PHARMACY***** Smith MA Youngkin EQ Managing the premenstrual syndrome. CLIN PHARM 1986 Oct; 5(10):788-97 The definition, classification, proposed etiologies, diagnosis, and treatment of the premenstrual syndrome (PMS) are discussed, and guidelines for the clinical management of PMS are presented. PMS encompasses a cluster of physical and psychosocial symptoms that recur during each menstrual cycle. Proposed etiologies for the syndrome include a hormonal imbalance between estrogen and progesterone, pyridoxine hydrochloride deficiency, hypoglycemia, excess prostaglandin production, and increased aldosterone concentrations in the luteal phase of the menstrual cycle. Diagnosis of PMS is usually based on a patient's history of recurrent symptoms accompanied by a seven-day, symptom-free period in the first half of the menstrual cycle. Management of PMS is complicated by the difficulty in diagnosing the syndrome and its unclear etiology. If possible, conservative nonpharmacologic treatment should be tried initially; suggested measures include modifications in diet, exercise, substance use, stress factors, rest patterns, and social support. Pharmacologic treatment should be considered when conservative therapies are ineffective or when PMS symptoms are more severe. Although most therapies are empirical, treatment with progesterone, pyridoxine, bromocriptine, or diuretics might prove beneficial. Once the decision is made to initiate drug therapy, the treatment regimen should be individualized and based on the patient's PMS symptom complex. The clinical management of PMS is complicated by the lack of well-designed clinical investigations of proposed treatments. Future research should be directed toward evaluating the efficacy of proposed therapeutic regimens. American Society of Hospital Pharmacists Bethesda MD 20814. *****CURRENT MEDICAL RESEARCH AND OPINION***** Vellacott ID Shroff NE Pearce MY Stratford ME Akbar FA A double-blind, placebo-controlled evaluation of spironolactone in the premenstrual syndrome. CURR MED RES OPIN 1987; 10(7):450-6 The effect of spironolactone in the alleviation of the symptoms of the premenstrual syndrome was compared with placebo in a double- blind, parallel group controlled study. One tablet daily of 100 mg spironolactone or placebo was given to 63 women from Day 12 of the menstrual cycle until the first day of the next menstrual bleed. This regimen was repeated for two consecutive cycles. Spironolactone was statistically significantly superior in providing relief from bloatedness (p less than 0.001). No statistically significant changes were observed in blood biochemistry of plasma hormone levels of oestradiol, progesterone or prolactin, though an increase in serum aldosterone levels was seen in the spironolactone-treated group. No differences were detected in weight, blood pressure or the incidence and severity of complaints following treatment. St. Thomas' Hospital London England. *****DRUG INTELLIGENCE AND CLINICAL PHARMACY***** True BL Goodner SM Burns EA Review of the etiology and treatment of premenstrual syndrome. DRUG INTELL CLIN PHARM 1985 Oct; 19(10):714-22 Premenstrual syndrome (PMS) is a diagnostic enigma that causes significant morbidity in many woman. Numerous theories have been proposed in an attempt to explain the varied symptoms that occur cyclically in women with PMS. Suggested etiologic theories of PMS include psychological abnormalities, nutritional deficiencies, aberrations in the renin-angiotensin-aldosterone axis, altered prostaglandin activity, hormonal imbalances, and changes in endogenous opioid peptide activity. Because of the lack of standardized diagnostic criteria, clinical drug trials for PMS have been severely compromised. For every proposed cause of PMS, there exists a drug or drug class that has been investigated for treatment of the associated symptoms. Many clinical studies are uncontrolled, a significant deficiency in study design for a disorder that is associated with a high placebo response rate. At the present time, no definitive treatment for PMS exists and therapy must be individualized according to clinical response. This review article defines PMS, describes one of the current approaches to the diagnostic work-up, discusses the proposed etiologies of PMS, and reviews the various proposed treatment modalities. College of Pharmacy University of Iowa Iowa City 52242 *****GIORNALE DI CLINICA MEDICA***** Bordoni A Biagi PL Turchetto E Serroni P De Jaco AP Orlandi C [Treatment of premenstrual syndrome with essential fatty acids (evening primrose oil)] G CLIN MED 1987 Jan; 68(1):23-8 (Published in ITALIAN) *****HEALTH CARE FOR WOMEN INTERNATIONAL***** Heinz SA Premenstrual syndrome: an assessment, education, and treatment model. HEALTH CARE WOMEN INT 1986; 7(1-2):153-7 Rome E Premenstrual syndrome (PMS) examined through a feminist lens. HEALTH CARE WOMEN INT 1986; 7(1-2):145-51 *****HOSPITAL AND COMMUNITY PSYCHIATRY***** Haskett RF Steiner M Diagnosing premenstrual tension syndrome. HOSP COMMUNITY PSYCHIATRY 1986 Jan; 37(1):33-6 The presence of a premenstrual tension syndrome (PMTS) should be considered during the clinical assessment of any women of childbearing age with intermittent or fluctuating psychological symptoms. Appropriate identification of this disorder depends on knowledge of its specific diagnostic features, most particularly its time-limited course. The clinician must also be aware that the syndrome can coexist with, exacerbate, or be exacerbated by other psychological distress or illness. Through the presentation of four case histories, the authors discuss the diagnostic complexities of PMTS and the treatment implications of a diagnosis of PMTS. Department of Psychiatry University of Michigan Medical School Ann Arbor 48109 *****HUMAN NUTRITION. CLINICAL NUTRITION***** van den Berg H Louwerse ES Bruinse HW Thissen JT Schrijver J Vitamin B6 status of women suffering from premenstrual syndrome. HUM NUTR CLIN NUTR 1986 Nov; 40(6):441-50 The vitamin B6 status of women suffering from premenstrual symptoms (PMS, n = 19) and a group of matched controls (n = 19) has been investigated. The women volunteering in the study were selected on strictly defined criteria. Several biochemical parameters of the metabolism of vitamin B6 and tryptophan were studied in blood and urine samples during a full menstrual cycle. No significant differences in plasma pyridoxal and pyridoxal-5'-phosphate (PLP) concentrations, the holo and total EGOT activity, the erythrocyte pyridoxine kinase activity and the urinary 4-pyridoxic acid excretion between the two groups were observed. The excretion of the tryptophan metabolites xanthurenic acid (XA) and 8-methyl-xanthurenic acid (MXA), before as well as after an oral tryptophan load, tended to be higher for the PMS group. Each of the groups showed a significant cyclic variation during the menstrual cycle in the holo and total EGOT activities and in the excretion of XA and MXA before as well as after an oral tryptophan load. It is concluded that PMS is not related to a 'cyclic' vitamin B6 status. The slight differences observed for tryptophan metabolism between the PMS and the control group deserve further study. TNO-CIVO Toxicology and Nutrition Institute Department of Clinical Biochemistry Zeist The Netherlands. Ritchie CD Singkamani R Plasma pyridoxal 5'-phosphate in women with the premenstrual syndrome. HUM NUTR CLIN NUTR 1986 Jan; 40(1):75-80 Measurements of plasma pyridoxal 5'-phosphate (PLP) were made in 210 healthy premenopausal women, and related to their experience of the premenstrual syndrome (PMS). The 41 women (20 per cent) who had moderate or severe PMS were compared with 95 women (45 per cent) with no, or only slight, premenstrual symptoms: the former group were older and were more likely to have children, but there were no significant differences in smoking habits or mode of contraception. Plasma PLP values were similar in the two groups (mean values with s.d. 39.59 +/- 22.95 and 40.56 +/- 23.33 nmol/l respectively). We conclude that pyridoxine status, as measured by plasma PLP levels, is not altered in women with PMS and that pyridoxine deficiency is unlikely to contribute to the occurrence of this syndrome. BUPA Medical Research London UK *****INDIANA MEDICINE***** Spitz AD Premenstrual syndrome. A critical review of the literature. INDIANA MED 1987 Apr; 80(4):378-82 *****INTERNATIONALE ZEITSCHRIFT FUR VITAMIN- UND ERNAHRUNGSFORSCHUNG. BEIHE***** Gunn AD Vitamin B6 and the premenstrual syndrome (PMS). INT J VITAM NUTR RES [SUPPL] 1985; 27:213-24 *****JOURNAL OF ABNORMAL PSYCHOLOGY***** McMillan MJ Pihl RO Premenstrual depression: a distinct entity. J ABNORM PSYCHOL 1987 May; 96(2):149-54 *****JOURNAL OF AFFECTIVE DISORDERS***** Dennerstein L Morse C Gotts G Brown J Smith M Oats J Burrows G Treatment of premenstrual syndrome. A double-blind trial of dydrogesterone. J AFFECTIVE DISORD 1986 Nov-Dec; 11(3):199-205 A double-blind randomised crossover trial of oral micronised progesterone and placebo had demonstrated that progesterone had beneficial effects over placebo for some mood and physical premenstrual symptoms. A further trial using identical methodology was carried out to assess whether dydrogesterone would have the same beneficial effects. Prospective assessment confirmed the presence of a premenstrual syndrome in 30 women. Of these, six withdrew during the 4 months of the study. Twenty-four women completed the double- blind crossover protocol. All women were interviewed premenstrually before treatment and in each month of treatment. They completed the Moos Menstrual Distress Questionnaire, Beck Depression Inventory, Spielberger State Anxiety Inventory, Mood Adjective Checklist and a Daily Symptom Record. Analysis of data found an overall beneficial effect of being treated for most variables. Further analysis showed that the most major effects occurred in the first 2 treatment months. This study could find no evidence that dydrogesterone was more effective than placebo in treating premenstrual complaints. Department of Psychiatry University of Melbourne Parkville Vic. Australia. Rubinow DR Roy-Byrne P Hoban MC Grover GN Stambler N Post RM Premenstrual mood changes. Characteristic patterns in women with and without premenstrual syndrome. J AFFECTIVE DISORD 1986 Mar-Apr; 10(2):85-90 Methodologic errors have compromised previous attempts to establish the relationship between mood and menstruation in women with the premenstrual syndromes. These syndromes cannot be diagnosed by history and require confirmation with longitudinal, prospective ratings. In this paper we present the characteristic pattern of mood changes in women with and without menstrually-related mood syndrome. The theoretical and diagnostic implications of the pattern differences are discussed. Biological Psychiatry Branch NIMH Bethesda, MD Endicott J Nee J Cohen J Halbreich U Premenstrual changes: patterns and correlates of daily ratings. J AFFECTIVE DISORD 1986 Mar-Apr; 10(2):127-35 Daily ratings of 20 measures of mood, behavior, and physical condition made by 64 women for one menstrual cycle were analysed to determine patterns of covariance between the pre- and postmenstrual periods. Five discriminantly different dimensions of premenstrual change were identified. They were found to be differentially related to a lifetime diagnosis of affective disorder. These results, and others, support the recommendation that research should be focused upon diversified premenstrual changes rather than a single premenstrual syndrome. Department of Research Assessment and Training New York State Psychiatric Institute NY 10032 Mackenzie TB Wilcox K Baron H Lifetime prevalence of psychiatric disorders in women with perimenstrual difficulties. J AFFECTIVE DISORD 1986 Jan-Feb; 10(1):15-9 Fifty-eight women age 30-40 years, blind to the purpose of the study were segregated according to whether they reported none-mild or moderate-severe perimenstrual difficulties on screening interview. Lifetime prevalence of major psychiatric disorders was ascertained using the Diagnostic Interview Schedule. Women in the moderate-severe group (n = 29) showed a significantly greater lifetime prevalence of affective disorders and drug abuse. No cases of somatization disorder were detected in either group. Department of Psychiatry University of Minnesota Minneapolis 55455 *****JOURNAL OF THE AMERICAN MEDICAL WOMENS ASSOCIATION***** Severino SK Anderson M Hurt SW Williams NA Understanding premenstrual syndrome. J AM MED WOM ASSOC 1987 Jan-Feb; 42(1):22-4 *****JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING***** Brown MA Zimmer PA Personal and family impact of premenstrual symptoms. J OBSTET GYNECOL NEONATAL NURS 1986 Jan-Feb; 15(1):31-s8 An exploratory study of premenstrual symptomatology, coping strategies, personal and family impact, and alterations in family functioning attributed to premenstrual symptoms was conducted. A sample of 83 women and 32 men completed a questionnaire before an evening lecture on premenstrual syndrome. Women reported a total of 74 different recurrent premenstrual symptoms, with the most frequently reported category being the "tension states." Men used multiple coping techniques to deal with their spouse's symptoms with offering support and expressing anger as the most frequently reported. Recurrent negative family impact themes emerged from the content analysis: increased conflict, decreased family cohesion, and disrupted communication among family members. Nursing implications are discussed. University of Washington School of Nursing Department of Community Health Care, Seattle 98195 Coyne CM Woods NF Mitchell ES Premenstrual tension syndrome. J OBSTET GYNECOL NEONATAL NURS 1985 Nov-Dec; 14(6):446-54 The premenstrual syndrome is discussed in relation to prevalence, symptomatology, severity, and time course. Methodologic problems common to the study of the menstrual cycle are presented. The research on psychologic and physiologic etiologies is reviewed, and results of studies on various treatment modes are discussed. Newer theories suggesting a combined psychophysiologic etiology and concomitant nonpharmaceutical treatment modes encompassing self-care and stress management skills are included. University Hospital Seattle WA 98195 *****JOURNAL OF PSYCHOSOMATIC RESEARCH***** Hart WG Coleman GJ Russell JW Assessment of premenstrual symptomatology: a re-evaluation of the predictive validity of self-report. J PSYCHOSOM RES 1987; 31(2):185-90 The predictive validity of subjects' self-reports of the severity of four groups of symptoms associated with the premenstrual syndrome (PMS) was assessed by canonical correlation of retrospective self- reports of usual symptom severities with prospectively obtained symptom severity scores from the next two cycles. Prospective scores from the second cycle were then correlated with retrospective recall scores obtained after the end of that cycle. A measure of inter-cycle variability was obtained by correlation between two consecutive sets of prospective scores. The symptoms studied were tension, depression, cognitive and physical ('water retention') symptoms. It was found that subjects' recall of a particular cycle predicted 72% of the variance in that cycle's prospective severity scores, indicating that the subjects correctly interpreted the severity of premenstrual symptoms and distinguished them from symptoms present in the follicular part of the cycle. Retrospective reports of usual PMS symptomatology predicted 21% of the variance in symptom scores in the next menstrual cycle and 12% of the variance in the following one. Despite this decrease, averaging the scores from the two prospective cycles improved the prediction to 23%. Prospective scores from one cycle predicted only 14% of the variance in prospective scores from the next, suggesting a high degree of inter-cycle variability. Women's self-reports of their usual PMS symptomatology reflect their experience more accurately than has been thought. The finding of marked inter-cycle variability suggests that arguments for the use of a single cycle of prospective data in PMS evaluation are fallacious and that retrospective self-report may be clinically useful and relatively valid. Health Psychology Centre School of Behavioural Sciences Lincoln Institute of Health Sciences Carlton Victoria Australia. Marriott A Faragher EB An assessment of psychological state associated with the menstrual cycle in users of oral contraception. J PSYCHOSOM RES 1986; 30(1):41-7 Reports of state in relation to the menstrual cycle were investigated using daily measures of state in a group of 65 family planning clinic attenders without pre-existing menstrual complaint. Women reported significant changes in their physical and psychological state prior to menstruation which reverted to "normal' levels 3-5 days after the onset of menstruation. No statistically significant differences were found between the patterns of oral contraceptive users and non-users. Department of Clinical Psychology Manchester Royal Infirmary Swinton Grove, U.K Metcalf MG Hudson SM The premenstrual syndrome: selection of women for treatment trials. J PSYCHOSOM RES 1985; 29(6):631-8 Statements made at interview by 31 women presenting with the premenstrual syndrome (PMS) were compared with the moods and physical symptoms reported daily during the next 6 menstrual cycles. Diagnosis was confirmed in 21 women (premenstrual tension (PMT) present in greater than or equal to 5/6 cycles), not substantiated in two (PMT in less than or equal to 1/6 cycles) and in doubt in eight. Placebo treatment was associated with a significant over-all reduction in both the incidence and the severity of mood-related PMT, but had no clear effect on premenstrual physical symptoms; women with PMT in 5 cycles were usually placebo-resistant. Criteria are proposed for the selection of women for treatment trials based on their response to placebo. Department of Endocrinology Princess Margaret Hospital Christchurch, New Zealand Stout AL Steege JF Psychological assessment of women seeking treatment for premenstrual syndrome. J PSYCHOSOM RES 1985; 29(6):621-9 One hundred (100) women who sought evaluation for premenstrual syndrome were administered a battery of standardized psychological tests, including a Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI) and Short Marital Adjustment Scale (MAS), during the follicular phase of the menstrual cycle. A BDI was repeated in the luteal phase of the menstrual cycle. MMPI profiles were classified by code type using Lachar system as follows: 'Normal'--36%; 'Neurotic'--31%; 'Characterological'--11%, 'Psychotic'- -5%, 'Unclassified'--17%. A common feature of MMPI profiles was a low Scale 5 (Mf). BDI scores had several patterns; however, a significant group (25%) appeared to have clinically significant continuous depression regardless of superimposed premenstrual changes. About half of the women (42%) reported marital distress (MAS scores less than 100) at the time of evaluation. Department of Obstetrics and Gynecology Duke University Medical Center Durham, North Carolina 27710 *****JOURNAL OF THE ROYAL COLLEGE OF GENERAL PRACTITIONERS***** Taylor RJ Alexander DA Fordyce ID A survey of paramenstrual complaints by covert and by overt methods. J R COLL GEN PRACT 1986 Nov; 36(292):496-9 Alexander DA Taylor RJ Fordyce ID Attitudes of general practitioners towards premenstrual symptoms and those who suffer from them. J R COLL GEN PRACT 1986 Jan; 36(282):10-2 *****MEDICAL HYPOTHESES***** Coulson CJ Pre-menstrual syndrome--are gonadotropins the cause of the condition? MED HYPOTHESES 1986 Mar; 19(3):243-55 It is proposed that premenstrual syndrome results from the action of elevated gonadotropin levels in various tissues of body other than their natural target organs. These levels are derived from an increased sensitivity to estrogen after pregnancy, childbirth, etc., particularly with respect to the positive feedback on gonadotropin release from the pituitary. Estrogen in conjunction with gonadotropin- releasing hormone (GnRH) releases excessive amounts of follicle- stimulating hormone (FSH) and luteinizing hormone (LH) at ovulation and in the premenstrual phase (post-menopausal patients have greatly elevated gonadotropins and can also demonstrate cyclic symptoms). Gonadotropin action via adenylate cyclase in the adrenal cortex elevates cortisol, while antagonism of parathyroid hormone action on bone gives rise to hypocalcemia. The physiological and psychological symptoms may thereby be explained. *****NEW MEXICO NURSE***** Raloff TB Pre-menstrual syndrome (PMS). NM NURSE 1985 Summer; 30(2):6 *****OHIO MEDICINE***** Price WA DiMarzio LR Eckert JL Correlation between PMS and alcoholism among women. OHIO MED 1987 Mar; 83(3):201-2 Price WA DiMarzio LR Gardner PR Premenstrual syndrome: answers to commonly asked questions. OHIO STATE MED J 1986 Aug; 82(8):554-6, 560 *****PERCEPTUAL AND MOTOR SKILLS***** Kuczmierczyk AR Adams HE Calhoun KS Naor S Giombetti R Cattalani M McCann P Pain responsivity in women with premenstrual syndrome across the menstrual cycle. PERCEPT MOT SKILLS 1986 Oct; 63(2 Pt 1):387-93 11 women with a clinical diagnosis of Premenstrual Syndrome (PMS) and 10 control women with no such diagnosis were compared on pain threshold and pain-tolerance measures in the intermenstrual and premenstrual phases of their menstrual cycles. No significant differences were found between the groups for behavioral measures of pain sensitivity. Ratings of pain intensity, however, were higher in both phases for the PMS group. Department of Psychiatry University of Rochester School of Medicine and Dentistry New York 14642. *****PHYSIOLOGY AND BEHAVIOR***** Jones DY Influence of dietary fat on self-reported menstrual symptoms. PHYSIOL BEHAV 1987; 40(4):483-7 The Moos Menstrual Distress Questionnaire (MMDQ) was completed by thirty healthy premenopausal women randomized into one of two sets of weight-maintaining diets, those with a ratio of polyunsaturated to saturated fatty acids (P/S ratio) of 1.0 and those with a P/S ratio of 0.3. After a baseline interval of one menstrual cycle, both groups were fed a high fat diet (40% energy from fat) for four menstrual cycles per subject, followed by a similar interval on a low fat diet (20% energy from fat). There were no significant differences in self- reported menstrual symptoms between the two P/S groups. During both menses and the premenstrual week of the low fat dietary period there were significant decreases in self-reported symptoms associated with water retention. A decrease in symptoms in the group labelled "arousal" during the rest of the menstrual cycle was also reported. Cancer Prevention Studies Branch National Cancer Institute Bethesda MD 20892. *****PROGRESS IN NEURO-PSYCHOPHARMACOLOGY AND BIOLOGICAL PSYCHIATRY***** Haskett RF Premenstrual dysphoric disorder: evaluation, pathophysiology and treatment. PROG NEUROPSYCHOPHARMACOL BIOL PSYCHIATRY 1987; 11(2-3):129-35 A small percentage of women describe a prominent dysphoric disturbance that is present during the premenstrual week, remits soon after the onset of menses and produces significant impairment in domestic, social or occupational functioning. Premenstrual dysphoric disorder must be distinguished from minor premenstrual emotional changes, from dysmenorrhea and from premenstrual exacerbations of psychiatric illness. Diagnostic evaluation should include the prospective assessment of symptoms over at least two complete menstrual cycles. Although the pathophysiology of premenstrual dysphoric disorder is linked to cycling of the intact hypothalamo- pituitary-gonadal axis, many studies have contained serious methodological weaknesses and no single etiological theory has received widespread support. No single pharmacological treatment has been shown to be clearly more effective than placebo in controlled studies and premenstrual dysphoric disorder appears to respond favorably to most interventions in uncontrolled studies. Interruption of pituitary-ovarian cycling will alleviate premenstrual symptoms, but treatments of this type cannot be recommended for general use until potential hazards are clarified. Department of Psychiatry University of Michigan Medical School Ann Arbor. *****PSYCHIATRY RESEARCH***** Roy-Byrne PP Rubinow DR Hoban MC Parry BL Rosenthal NE Nurnberger JI Byrnes S Premenstrual changes: a comparison of five populations. PSYCHIATRY RES 1986 Feb; 17(2):77-85 Several studies have suggested that a special relationship exists between premenstrual and major affective disorders. The present report describes the incidence of reported premenstrual symptoms in women with and without prospectively confirmed premenstrual syndrome, women with bipolar or seasonal affective disorder, and controls. The inability of reported symptoms to differentiate women with and without confirmed premenstrual syndrome, as well as the reduced prevalence of reported premenstrual changes in our affective populations relative to previous reports, is discussed. Biological Psychiatry Branch National Institute of Mental Health (NIMH) Bethesda, MD 20205 *****PSYCHOLOGIE MEDICALE***** Crammer JL Premenstrual depression, cortisol and oestradiol treatment. PSYCHOL MED 1986 May; 16(2):451-5 A woman with a 5-year history of frequently recurrent depressions responded poorly to the usual antidepressants. She had a raised plasma cortisol and was made worse by progesterone or by ACTH. An oestradiol/testosterone implant every 4 months abolished all symptoms for at least 8 years, and plasma cortisol returned to normal. This case is relevant to an understanding of premenstrual syndromes and the genesis of depressive illness. Institute of Psychiatry London *****PSYCHOPHARMACOLOGY BULLETIN***** Harrison WM Endicott J Rabkin JG Nee JC Sandberg D Treatment of premenstrual dysphoria with alprazolam and placebo. PSYCHOPHARMACOL BULL 1987; 23(1):150-3 *****PSYCHOSOMATISCHE MEDIZIN = MEDECINE PSYCHOSOMATIQUE = MEDICINA PSICOSO***** Leon GR Phelan PW Kelly JT Patten SR The symptoms of bulimia and the menstrual cycle. PSYCHOSOM MED 1986 Jul-Aug; 48(6):415-22 A group of 45 women meeting DSM-III diagnostic criteria for bulimia were followed for a 9-week period to assess a possible relationship between a premenstrual syndrome and exacerbations of binging and other eating problem behaviors. A possible interface with a cyclothymic behavior disorder was also evaluated. The results of the daily recording (with subjects blind to the study hypotheses) identified eight women with a premenstrual pattern, but these changes in mood and physical complaints were unrelated to changes in food consumption. A cyclothymic behavior pattern was found in 10 women (22.2%), with a relatively earlier age of onset of bulimia in this group. Department of Psychology University of Minnesota Minneapolis 55455 Logue CM Moos RH Perimenstrual symptoms: prevalence and risk factors. PSYCHOSOM MED 1986 Jul-Aug; 48(6):388-414 This article provides an overview of information on the prevalence of perimenstrual symptoms. Overall, at least 40% of women experience some cyclical perimenstrual symptoms. Although most women rate their symptoms as mild, approximately 2%-10% report severe symptoms. Prospective studies of perimenstrual symptoms indicate that retrospective reports are reasonably accurate among women who experience moderate to severe symptoms. However, among the majority of women with few or minimal symptoms, retrospective reports may amplify the cyclicity of variation in comparison to concurrent reports. A variety of risk factors are associated with patterns of symptom reporting and may provide clues to the etiology of perimenstrual symptoms and help to identify women most vulnerable to them. A woman's age and cycle characteristics are predictors of the type and severity of perimenstrual symptoms she experiences. In addition, a history of affective illness may be associated with increased reporting of perimenstrual symptoms. Future research should focus on developing new diagnostic criteria for subtypes of perimenstrual syndromes, exploring positive symptoms and experiences associated with the menstrual cycle, and formulating holistic treatment approaches that view perimenstrual syndromes as psychosomatic conditions. Social Ecology Laboratory Stanford University CA 94305 Brooks-Gunn J Differentiating premenstrual symptoms and syndromes [editorial] PSYCHOSOM MED 1986 Jul-Aug; 48(6):385-7 *****PSYCHOSOMATICS***** Sondheimer SJ Freeman EW Scharlop B Rickels K Hormonal changes in premenstrual syndrome. PSYCHOSOMATICS 1985 Oct; 26(10):803-6, 809-10 Harrison WM Rabkin JG Endicott J Psychiatric evaluation of premenstrual changes. PSYCHOSOMATICS 1985 Oct; 26(10):789-92, 795, 798-9 *****PSYCHOTHERAPIE, PSYCHOSOMATIK, MEDIZINISCHE PSYCHOLOGIE***** Schwarzer R van der Ploeg HM [Emotional changes in the menstrual cycle--the premenstrual syndrome] PSYCHOTHER PSYCHOSOM MED PSYCHOL 1987 Jul; 37(7):237-43 (Published in GERMAN) *****RESEARCH IN NURSING AND HEALTH***** Shaver JF Woods NF Concordance of perimenstrual symptoms across two cycles. RES NURS HEALTH 1985 Dec; 8(4):313-9 The prevalence of perimenstrual symptoms usually is based on reports for one menstrual cycle; the consistency of symptoms across cycles is ignored. The purpose of this investigation was to determine perimenstrual symptoms reported concordantly for two menstrual cycles in a group of 63 presumably healthy women reporting symptoms in health diaries over 2 months. There were only nine symptoms for each of the menstrual and premenstrual phases reported by the same woman across both cycles. Furthermore, concordance of perimenstrual symptom reporting across the two cycles was significant only for backache (kappa = .636, p less than .0001), headache (kappa = .849, p less than .001), and cramps (kappa = .899, p less than .001) in the menstruum and for backache (kappa = 0.123, p less than .0001), cold sweats (kappa = .500, p less than .0001), fatigue (kappa = .135, p less than .0001), depression (kappa = .268, p less than .0002), and tension (kappa = .320, p less than .0001) in the premenstruum. Several symptoms showed high prevalence during the remainder of the cycle which might contribute to the lack of concordance. These data imply that prevalence estimates based on only one menstrual cycle may be inaccurate overall and inadequate as baseline or followup estimates by which to evaluate therapeutic intervention. Department of Physiological Nursing School of Nursing University of Washington, Seattle 98195 *****WOMEN AND HEALTH***** Asso D Psychology degree examinations and the premenstrual phase of the menstrual cycle. WOMEN HEALTH 1985-86 Winter; 10(4):91-104 Questions are frequently raised about possible impairment of cognitive function in the premenstrual phase of the menstrual cycle. There is also concern that women may be at a disadvantage premenstrually on important occasions such as examinations. This study compared the marks on final-year psychology degree examinations in the premenstrual phase with those of the rest of the cycle. All of the 26 women students who were eligible to participate did so. Comparisons, within and between individuals, of Premenstrual and Nonpremenstrual marks, gave no indication of significant fluctuations with the cycle. Pre-examination arousal and anxiety, which were similar to the relevant published norms, did not appear to be related to the examination marks. There were no significant differences between students taking or not taking oral contraceptives. If there are any physiological and/or social-psychological effects of the cycle on high-level cognitive functioning these are presumably compensated for by the students in this situation. These findings suggest that women taking final degree examinations are not at a disadvantage during the premenstrual phase of the cycle. Department of Psychology University of London Goldsmiths' College Connect Time = 42.05 Minutes Connect Time Charge @ $16.00/HR 11.21 Communications Charge @ 6.00/HR 4.21 Search Element @ .10 .80 Reference Display @ .10 .20 Reference Print @ .10 14.80 Title Scan @ .05 13.85 Abstract Print @ .10 11.00 Total Search Cost $ 56.07