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Changes in Premenstrual Symptoms in Women With Schizophrenia: A Prospective Study

Yong-In Mental Hospital (S.-H.C., S.-B.K.), Yongin City, Kyunggi Province, South Korea; and Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea.

Address reprint requests to: So-Hyun Choi, MD, PhD, Yong-In Mental Hospital, 4 Sangha-Ri, Kusung-Myun, Yongin City, Kyunggi Province, South Korea 449-910. Email: cshi{at}unitel.co.kr

OBJECTIVE: We investigated whether the psychiatric symptoms and clinical features of schizophrenia change during the premenstrual phase in female patients.

METHODS: We observed 30 female schizophrenic inpatients over one menstrual cycle. All subjects met DSM-IV criteria for schizophrenia, and all had a regular menstrual cycle. All subjects completed the Daily Rating Form (DRF) every evening, and one psychiatrist rated the subjects (using the Brief Psychiatric Rating Scale [BPRS]) once during each of the three menstrual phases (premenstrual, menstrual, and postmenstrual). Serum levels of estradiol (E₂) and progesterone were measured on the fifth to seventh day of both the premenstrual and postmenstrual phases. Data from the 24 subjects who completed the DRF correctly and completely were used for statistical analysis.

RESULTS: The mean total BPRS score for the 24 subjects was highest in the premenstrual phase and lowest in the postmenstrual phase, and a statistically significant difference was found among the three menstrual phases. Mean subtotal BPRS scores showed statistically significant differences among the three menstrual phases in anxiety/depression and withdrawal/retardation, but not in the psychotic symptom subscales. Mean serum E₂ level showed a trend of increasing from the premenstrual phase to the postmenstrual phase. However, there was no significant correlation between BPRS and E₂. When the criterion of 30% change was applied, the DRF items of depressed mood, anxious/nervous/restless, hostile/aggressive, and less/impaired work showed high frequencies of change in the premenstrual phase. Somatic items of abdominal pain, breast pain, and headache showed significant change with the 30% change rule on the DRF. On both the BPRS and DRF scores, premenstrual change of affective and behavioral symptoms was prominent, whereas the change of psychotic symptoms was minimal on the BPRS. In addition, in the premenstrual phase, there was a statistically significant correlation between the total BPRS score and the mean total DRF score. There was no correlation between premenstrual change in symptoms and hormonal levels of E₂, progesterone, and the estradiol/progesterone (E/P) ratio.

CONCLUSIONS: The findings of this study suggest that premenstrual exacerbation of schizophrenic symptoms in female patients may not be a worsening of the schizophrenic symptoms but a concurrence of affective, behavioral, and somatic symptoms.

Key Words: premenstrual symptom change • schizophrenia • premenstrual syndrome • estrogen • Daily Rating Form • Brief Psychiatric Rating Scale

Abbreviations: BPRS = Brief Psychiatric Rating Scale; DRF = Daily Rating Form; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; E₂ = estradiol; E/P ratio = estradiol/progesterone ratio; MDS = menstrual distress syndrome; PG = progesterone; PMDD = premenstrual dysphoric disorder; PMS = premenstrual syndrome