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Is menstrual Psychosis a Forgotten Entity?

Ashvini Vengadavaradan1, Gopinath Sathyanarayanan1, Pooja Patnaik Kuppili1

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Menstrually-related psychosis, a rare condition, involves cyclical psychotic symptoms linked to menstrual cycles. Estrogen fluctuations may play a role, with treatment showing promise.

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Area of Science:

  • Psychiatry
  • Neuroendocrinology
  • Reproductive Medicine

Background:

  • The link between menstruation and psychosis is historically recognized but sparsely documented in modern literature.
  • Cyclical psychosis, often presenting with polymorphic symptoms, can manifest premenstrually or at the onset of menses.

Observation:

  • A case of a 42-year-old woman experiencing cyclical psychosis tied to her menstrual cycle is presented.
  • Symptoms included irritability, aggression, persecutory delusions, hallucinations, disorganized behavior, and poor self-care, lasting approximately 20 days per cycle.
  • The cyclical pattern persisted for seven years, beginning 13 years after her last childbirth.

Findings:

  • The patient responded well to risperidone, with symptom remission during the subsequent menstrual cycle.
  • Discontinuation of medication led to a relapse, confirming the cyclical nature and treatment responsiveness.
  • Hormonal assays showed normal gonadal hormone levels, suggesting a complex interplay beyond simple hormonal deficiency.

Implications:

  • This case highlights the importance of considering menstrual cycle-related factors in the diagnosis and management of psychosis in women.
  • The findings support the hypothesis that cyclical estrogen fluctuations during the menstrual cycle may trigger psychosis in susceptible individuals.
  • Further research into the neuroendocrine mechanisms underlying menstrual psychosis is warranted to optimize therapeutic strategies.