Menstrual psychosis with a marked response to carbamazepine

Menstrual psychosis was first defined by Brockington in 1998 as a form of cycloid psychosis, the key features of which are an acute onset occurring against a background of normal mental functioning, brief duration, psychotic features, and a circadian periodicity that aligns with the menstrual cycle. Furthermore, menstrual psychosis is clearly distinguishable from menstrual syndrome and premenstrual dysphoric disorder, which are mood disorders related to the menstrual cycle, by the presence of psychotic symptoms. There are thus far only 80 reported cases of menstrual psychosis. As of yet, there is no consensus on its treatment, and antipsychotic and antidepressant therapies are considered ineffective.

We report herein a 17-year-old Japanese patient in whom psychotic symptoms appeared before, and resolved after, menstruation. The patient responded poorly to antipsychotic and antidepressant therapy, but carbamazepine administration led to a complete resolution of her symptoms.

Carbamazepine may be effective in some patients with cycloid psychotic symptoms fulfilling the diagnostic criteria for menstrual psychosis.