The chronopathology of premenstrual psychopathology

Psychopathology may occur with the following premenstrual chronopathologic characteristic : the symptoms begin about four days before menstruation and end within the first four days of menstrual flow. For the diagnosis of "premenstrual tension syndrome" (PMTS) the complaints must be present for four consecutive menstrual cycles. According to DSM-III criteria PMTS is a mental disorder of shared phenomenology. The major etiologic factor is hyperprolactinaemia alone or in combination with reduced plasma levels of oestrogen or progesteron during the final luteal phase. The premenstrual chronopathology of these three forms of hyperprolactinaemia may explain the pathogenesis of PMTS. Lithium appears to have a favourable effect on the chronopathologic disorder. As to the molecular mechanisms of the pathogenesis, the intracellular affects of prolactin or prostaglandin PGE1 are important. From a pathophysiologic point of view PMTS may be considered a deficiency of PGE1 activity in the hypothalamus and the temporal cortical areas. This is antagonized by lithium. Premenstrual exacerbations of depression or psychosis differ from PMTS as to their clinical symptoms, location, pathogenesis, pathophysiology and treatment. From a pathophysiologic point of view PGE1 may be involved here, too. Implications for further investigation are discussed.