[Cyclic psychosis associated with the menstrual cycle]

Cyclic psychosis associated with the menstrual cycle is an uncommon disorder, not included under the accepted definitions of functional psychoses. We present three female adolescents who developed an acute psychosis a few days before menstruation, which resolved completely upon bleeding or several days later, only to reappear in the same form in subsequent cycles. The clinical presentation was not in line with that of the typical functional psychoses. An extensive medical work-up did not show any significant disturbances, with the exception of anovulatory cycles in one youngster. Psychotropic treatment had no effect on the course of the psychosis. Treatment with progesterone in the second half of the cycle in one case, and with a combined progesterone/estrogen contraceptive agent in another, resulted in full recovery within several cycles. The third girl showed a spontaneous remission within four cycles. Remission continued in all cases after discontinuation of the hormonal treatment, and with no need to reintroduce any psychotropic agent, for a period of 2-4 years. We discuss several possible etiologic mechanisms for cyclic psychosis associated with the menstrual cycle, including it being a cycloid non-specific affective disorder, and its association with a temporary functional hypothalamic-pituitary dysfunction, and with anovulation. We also discuss the role of psychotropic and hormonal treatment in this disorder.