Lack of Efficacy of Antipsychotics on Premenstrual Psychosis: A Case Report

Premenstrual psychosis has been described as a psychotic condition beginning shortly before, or during menstruation, in adolescent girls and young women. In this article, we present a case that developed sudden onset psychosis a few days before menstruation which resolved completely upon menstrual bleeding. Importantly, the recovery from psychotic symptoms was independent of antipsychotic treatment. A 30 year-old female was diagnosed with disorganized type schizophrenia ten years prior to this case study. She first suffered from auditory hallucination and persecutory delusion after her first menstrual cycle when she was in elementary school. She was treated with oral haloperidone 20 mg per day. The psychotic symptoms were frequently recurrent and her family thought the recurrence was due to poor drug compliance. The patient then started to receive long term injections of risperidone one year ago. It was discontinued because of the lack of efficacy. Aripiprazole 10 mg per day was prescribed and thereafter titrated to 20 mg per day. During the following, vivid auditory hallucination, self-talking and self-laughing were frequently noted. There was no treatment effect of aripiprazole on these psychotic symptoms. In this case antipsychotic treatment was continuously received, including haloperidone, long term injection of risperidone and aripiprazole. However, psychotic features were still recurrent even in the presence of antipsychotic treatment. This case report suggests that cyclic psychoses associated with the menstrual cycle may be a specific entity, not included under the recognized functional psychoses. In some cases, these psychoses could be classified as a subgroup of premenstrual syndromes.