Lugansk State Medical University (LSMU) is attested according to the highest (the fourth) Level of accreditation. Lugansk State Medical University ranks third among Medical Universities in Ukraine & the higher medical schools and university of the 4th accreditation level according to the last ranking list of the Ministry of Health of Ukraine.The University activities conform with The Constitution of Ukraine, Ukrainian legislation, acts issued by the President and the Cabinet of Ministers of Ukraine, Decrees of the Health Department and Education Department of Ukraine, the University Rules .
This document discusses premenstrual changes (PMCs), also known as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMCs involve both psychiatric and gynecological symptoms that occur cyclically in the luteal phase before menstruation. Symptoms can range from mild mood changes to severe mental and physical disturbances. While the exact causes are unclear, serotonin levels are believed to play a role. Treatment involves lifestyle modifications and medications depending on symptom severity, with selective serotonin reuptake inhibitors and calcium supplements showing effectiveness for more severe symptoms.
The document discusses depression and insomnia, including their epidemiology, assessment, and evidence-based treatments. It notes that depression affects over 350 million people globally and is a leading cause of disability. Common treatments include cognitive behavioral therapy, behavioral activation, mindfulness-based therapies, and various medications. Insomnia impacts up to 35% of some populations and is associated with health risks. Evaluation of insomnia involves assessing sleep patterns and behaviors, while treatments focus on improving sleep hygiene, relaxation, and stimulus control.
The document discusses gender differences in depression across the female life cycle. It notes that depression is the leading cause of disease burden for women. Some key points made include that women have higher lifetime prevalence of depression compared to men, and are more likely to experience atypical symptoms. Depression risk for women varies at different life stages like puberty, reproductive years, menopause, and is also impacted by hormonal fluctuations, pregnancy, and hormone treatments. The document provides an overview of neurobiological factors like the role of estrogen and progesterone in mood, as well as sex differences in antidepressant response. It also discusses depressive disorders specific to women like premenstrual dysphoric disorder and postpartum depression.
Depressive illness can be characterized by a major depressive episode involving depressed mood and loss of interest for at least two weeks, accompanied by additional symptoms. Depression is a significant contributor to the global disease burden. The lifetime risk of developing a severe depressive episode is 12-16%. Neurobiological factors like the GSK3beta gene and decreased levels of brain-derived neurotrophic factor are implicated in depression. Physical symptoms are commonly the chief complaint in depressed patients, and there is overlap in the neurochemistry of depression and pain involving serotonin and norepinephrine. Untreated somatic depression can lead to structural brain changes and increased risk of persistent pain.
1. Psychosomatic disorders occur when mental stress or emotional factors negatively impact physical health. According to Unani medicine, disturbances in psychic faculties like the brain can lead to stress-related issues like depression.
2. Unani recognizes lifestyle factors like diet, exercise, sleep, and social support as essential to well-being. Imbalances in these "six essentials" as well as the temperament can contribute to psychosomatic disorders.
3. Treatment focuses on eliminating causes, correcting temperament imbalances, and strengthening the heart-mind connection. Approaches include dietary therapy, exercise, relaxation, and medications aimed at reducing stress symptoms.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
1. Secondary depression is depression that develops after the onset of a medical illness or other psychiatric disorder. The document discusses secondary depression in the context of several medical illnesses.
2. Depression commonly occurs secondary to neurological disorders like stroke, traumatic brain injury, Alzheimer's disease, Parkinson's disease, and other conditions. It can also arise secondary to cardiovascular, pulmonary, and other medical illnesses.
3. The symptoms of secondary depression are often indistinguishable from primary depression but the underlying causes and appropriate treatment approaches may differ. Managing both the medical condition and depressive symptoms is important.
This document discusses premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It covers the background, pathophysiology, diagnosis, and management. Key points include that PMS causes physical and psychological symptoms in the luteal phase prior to menstruation in about 90% of women. The pathophysiology is multifactorial and may involve hormones, genetics, and neurotransmitters. Diagnosis is based on history and symptom tracking. Management involves a multidisciplinary approach including lifestyle changes, vitamins, medications like SSRIs, hormonal contraceptives, and in severe cases surgery.
This document discusses premenstrual changes (PMCs), also known as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMCs involve both psychiatric and gynecological symptoms that occur cyclically in the luteal phase before menstruation. Symptoms can range from mild mood changes to severe mental and physical disturbances. While the exact causes are unclear, serotonin levels are believed to play a role. Treatment involves lifestyle modifications and medications depending on symptom severity, with selective serotonin reuptake inhibitors and calcium supplements showing effectiveness for more severe symptoms.
The document discusses depression and insomnia, including their epidemiology, assessment, and evidence-based treatments. It notes that depression affects over 350 million people globally and is a leading cause of disability. Common treatments include cognitive behavioral therapy, behavioral activation, mindfulness-based therapies, and various medications. Insomnia impacts up to 35% of some populations and is associated with health risks. Evaluation of insomnia involves assessing sleep patterns and behaviors, while treatments focus on improving sleep hygiene, relaxation, and stimulus control.
The document discusses gender differences in depression across the female life cycle. It notes that depression is the leading cause of disease burden for women. Some key points made include that women have higher lifetime prevalence of depression compared to men, and are more likely to experience atypical symptoms. Depression risk for women varies at different life stages like puberty, reproductive years, menopause, and is also impacted by hormonal fluctuations, pregnancy, and hormone treatments. The document provides an overview of neurobiological factors like the role of estrogen and progesterone in mood, as well as sex differences in antidepressant response. It also discusses depressive disorders specific to women like premenstrual dysphoric disorder and postpartum depression.
Depressive illness can be characterized by a major depressive episode involving depressed mood and loss of interest for at least two weeks, accompanied by additional symptoms. Depression is a significant contributor to the global disease burden. The lifetime risk of developing a severe depressive episode is 12-16%. Neurobiological factors like the GSK3beta gene and decreased levels of brain-derived neurotrophic factor are implicated in depression. Physical symptoms are commonly the chief complaint in depressed patients, and there is overlap in the neurochemistry of depression and pain involving serotonin and norepinephrine. Untreated somatic depression can lead to structural brain changes and increased risk of persistent pain.
1. Psychosomatic disorders occur when mental stress or emotional factors negatively impact physical health. According to Unani medicine, disturbances in psychic faculties like the brain can lead to stress-related issues like depression.
2. Unani recognizes lifestyle factors like diet, exercise, sleep, and social support as essential to well-being. Imbalances in these "six essentials" as well as the temperament can contribute to psychosomatic disorders.
3. Treatment focuses on eliminating causes, correcting temperament imbalances, and strengthening the heart-mind connection. Approaches include dietary therapy, exercise, relaxation, and medications aimed at reducing stress symptoms.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
1. Secondary depression is depression that develops after the onset of a medical illness or other psychiatric disorder. The document discusses secondary depression in the context of several medical illnesses.
2. Depression commonly occurs secondary to neurological disorders like stroke, traumatic brain injury, Alzheimer's disease, Parkinson's disease, and other conditions. It can also arise secondary to cardiovascular, pulmonary, and other medical illnesses.
3. The symptoms of secondary depression are often indistinguishable from primary depression but the underlying causes and appropriate treatment approaches may differ. Managing both the medical condition and depressive symptoms is important.
This document discusses premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It covers the background, pathophysiology, diagnosis, and management. Key points include that PMS causes physical and psychological symptoms in the luteal phase prior to menstruation in about 90% of women. The pathophysiology is multifactorial and may involve hormones, genetics, and neurotransmitters. Diagnosis is based on history and symptom tracking. Management involves a multidisciplinary approach including lifestyle changes, vitamins, medications like SSRIs, hormonal contraceptives, and in severe cases surgery.
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
This presentation introduces you to the different types of depression. Though there are general symptoms seen in all types of depression, there are symptoms specific to a particular type. This presentation includes the symptoms for each type of depression.
This document discusses depression, including its epidemiology, definitions, classification, diagnostic criteria, and treatment. Some key points:
- Depression is the 3rd leading cause of disease burden worldwide and is projected to become the leading cause by 2030.
- Major depression has a prevalence of 5% and 15% of the population will experience a major depressive episode at some point in their life.
- Depression is classified based on severity from mild to severe. Diagnosis requires a certain number of symptoms from major and minor criteria groups.
- Depression can be classified as unipolar (recurrent depression only) or bipolar (episodes of mania and depression).
- Causes of depression involve biological factors like neurotransmitter im
This document provides guidance on identifying and managing clinically significant depression for internists. It outlines how to take a thorough history to assess for depression, safety risks, substance use, bipolarity and psychosis. Common mimics of depression like delirium, substance withdrawal and medical condition-related depression are reviewed. First-line antidepressant medications are SSRIs, SNRIs, bupropion and mirtazapine. The document describes strategies for patients who do not improve on initial treatment, such as switching or augmenting medications. Non-pharmacological approaches like exercise and social support are also encouraged.
The document discusses depressive disorders, including major depressive disorder (MDD). Some key points:
- Depressive disorders are common worldwide and a leading cause of disability. MDD accounted for 8.2% of disabilities globally in 2010.
- Prevalence of depression varies widely between studies but is estimated to be 7.9-15.1% in India. Rates are higher in urban areas, primary care clinics, and the elderly.
- Depression is associated with high suicide rates, accounting for 50-70% of suicides. India has high suicide rates, with 37.8% of those committing suicide being under 30.
This document discusses premenstrual changes (PMCs), also known as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMCs are common cyclic affective disorders affecting young and middle-aged women, characterized by mood and physical symptoms in the luteal phase prior to menstruation. Mild symptoms affect 30-80% of women, while severe symptoms affect 3-5%. The exact causes are unclear but likely involve serotonin and hormonal fluctuations. Diagnosis involves tracking symptoms over at least two cycles to identify cyclic patterns. Treatment options range from lifestyle modifications to pharmacotherapy depending on symptom severity.
Depression is a common mental disorder characterized by depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, and poor concentration. There are several types of depression including major depressive disorder, dysthymic disorder, postpartum depression, and seasonal affective disorder. Symptoms include feelings of sadness, changes in appetite and sleep, fatigue, anxiety, and thoughts of death or suicide. Depression is caused by genetic, environmental, biochemical and physiological factors and can be effectively treated with antidepressant medication, psychotherapy like CBT or IPT, and lifestyle changes to reduce stress and improve sleep and social support.
This document provides an overview of dementia, including:
- Dementia is a general term for cognitive decline caused by various underlying diseases and disorders. Alzheimer's disease is the most common cause.
- Worldwide prevalence is around 50 million people currently living with dementia. This number is projected to reach 152 million by 2050 due to increased life expectancy.
- Risk factors for dementia include age, family history, head trauma, depression, and certain genetic disorders.
- Symptoms include memory loss, impaired thinking, orientation issues, personality changes, and difficulties with language.
- Dementia is classified based on its underlying cause such as Alzheimer's, vascular, or Lewy body dementia.
-
Complex eating disorder characterized by obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image
Anorexia nervosa is typically characterized by
voluntary restriction of food intake ,distorted body image and fear of gaining weight
Premenstrual Syndrome – Recent Guidelines
Premenstrual Syndrome & Premenstrual Dysphoric Disorder
Incidence
80% of women have atleast one physical or psychiatric symptom during luteal phase
PMS -12-15%
PMDD – 1.3-5.3%
Abstract of depression assessment:
- How to assess
- Differential diagnosis for physiologic causes vs. psychological
- Rating scales
*There are notes provided in some slides
This document discusses the potential role of neuromodulation, specifically repetitive transcranial magnetic stimulation (rTMS), in the treatment of anorexia nervosa (AN). AN is characterized by abnormalities in brain regions involved in reward processing, decision making, and interoception. Preliminary evidence suggests rTMS targeting the dorsolateral prefrontal cortex may improve core AN symptoms, mood, and self-regulation. Several small studies and case reports provide initial support that rTMS is a safe, tolerable and may have therapeutic potential for AN, but more rigorous randomized controlled trials are still needed.
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
The document discusses depression, including its definition, epidemiology, prevalence in India, etiology, risk factors, physical illnesses associated with it, and treatment options. It notes that depression is a common mental disorder characterized by depressed mood and loss of interest, and that globally over 350 million people suffer from it. Treatment includes lifestyle changes, psychotherapy, pharmacotherapy using antidepressants like SSRIs, SNRIs, and TCAs, and other options such as transcranial magnetic stimulation.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome that affects 3-8% of women, causing severe mood changes, anxiety, and impairment in functioning during the luteal phase of the menstrual cycle each month. While the exact causes are unknown, it likely involves an interaction between fluctuating hormone levels and central neurotransmitters like serotonin. Selective Serotonin Reuptake Inhibitors (SSRIs) are effective treatments for PMDD symptoms, suggesting serotonin involvement, though their mechanism of action is complex and not solely due to serotonin reuptake inhibition. PMDD diagnosis requires prospective tracking of symptoms and exclusion of other conditions.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
This document discusses psychiatric disorders in pregnant and lactating women. It provides information on how pregnancy can impact mental health and psychiatric disorders. Key points include how psychiatric disorders and medications can affect pregnancy and the fetus. It emphasizes the importance of screening and predicting mental health issues during pregnancy and postpartum. The document also discusses managing different mental disorders throughout pregnancy, delivery, and lactation.
Huntington's disease is an inherited, progressive brain disorder that causes uncontrolled movements, emotional issues, and loss of thinking abilities. It is caused by a defective gene that is inherited from a parent. Early symptoms vary but may include mood swings, personality changes, and abnormal body movements. Currently there is no cure, but medications and therapies can help manage symptoms. The condition steadily worsens over time and is ultimately fatal.
Premenstrual syndrome (PMS) is characterized by physical, psychological, and behavioral symptoms that recur monthly before menstruation. Nearly 200 symptoms have been associated with PMS. Severe symptoms occur in 3-5% of menstruating women. Genetics play a role, as concordance is higher in identical twins. Common symptoms include fatigue, irritability, mood changes, and physical issues like breast tenderness and bloating. Prospective daily tracking of symptoms is important to differentiate PMS from premenstrual dysphoric disorder (PMDD) or other conditions. Treatments include oral contraceptives, vitamin B6, antidepressants, and lifestyle changes. Placebo-controlled trials are needed to properly
PMS affects 40% of women and causes psychological and physical symptoms related to the menstrual cycle. The exact cause is unknown but likely involves sensitivity to hormone fluctuations. Diagnosis requires tracking symptoms over two cycles which improve after menstruation. Treatment depends on severity but may include lifestyle changes, SSRIs, COCPs, or suppressing ovulation. CBT and some supplements like Vitex and calcium can also help reduce symptoms.
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
This presentation introduces you to the different types of depression. Though there are general symptoms seen in all types of depression, there are symptoms specific to a particular type. This presentation includes the symptoms for each type of depression.
This document discusses depression, including its epidemiology, definitions, classification, diagnostic criteria, and treatment. Some key points:
- Depression is the 3rd leading cause of disease burden worldwide and is projected to become the leading cause by 2030.
- Major depression has a prevalence of 5% and 15% of the population will experience a major depressive episode at some point in their life.
- Depression is classified based on severity from mild to severe. Diagnosis requires a certain number of symptoms from major and minor criteria groups.
- Depression can be classified as unipolar (recurrent depression only) or bipolar (episodes of mania and depression).
- Causes of depression involve biological factors like neurotransmitter im
This document provides guidance on identifying and managing clinically significant depression for internists. It outlines how to take a thorough history to assess for depression, safety risks, substance use, bipolarity and psychosis. Common mimics of depression like delirium, substance withdrawal and medical condition-related depression are reviewed. First-line antidepressant medications are SSRIs, SNRIs, bupropion and mirtazapine. The document describes strategies for patients who do not improve on initial treatment, such as switching or augmenting medications. Non-pharmacological approaches like exercise and social support are also encouraged.
The document discusses depressive disorders, including major depressive disorder (MDD). Some key points:
- Depressive disorders are common worldwide and a leading cause of disability. MDD accounted for 8.2% of disabilities globally in 2010.
- Prevalence of depression varies widely between studies but is estimated to be 7.9-15.1% in India. Rates are higher in urban areas, primary care clinics, and the elderly.
- Depression is associated with high suicide rates, accounting for 50-70% of suicides. India has high suicide rates, with 37.8% of those committing suicide being under 30.
This document discusses premenstrual changes (PMCs), also known as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMCs are common cyclic affective disorders affecting young and middle-aged women, characterized by mood and physical symptoms in the luteal phase prior to menstruation. Mild symptoms affect 30-80% of women, while severe symptoms affect 3-5%. The exact causes are unclear but likely involve serotonin and hormonal fluctuations. Diagnosis involves tracking symptoms over at least two cycles to identify cyclic patterns. Treatment options range from lifestyle modifications to pharmacotherapy depending on symptom severity.
Depression is a common mental disorder characterized by depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, and poor concentration. There are several types of depression including major depressive disorder, dysthymic disorder, postpartum depression, and seasonal affective disorder. Symptoms include feelings of sadness, changes in appetite and sleep, fatigue, anxiety, and thoughts of death or suicide. Depression is caused by genetic, environmental, biochemical and physiological factors and can be effectively treated with antidepressant medication, psychotherapy like CBT or IPT, and lifestyle changes to reduce stress and improve sleep and social support.
This document provides an overview of dementia, including:
- Dementia is a general term for cognitive decline caused by various underlying diseases and disorders. Alzheimer's disease is the most common cause.
- Worldwide prevalence is around 50 million people currently living with dementia. This number is projected to reach 152 million by 2050 due to increased life expectancy.
- Risk factors for dementia include age, family history, head trauma, depression, and certain genetic disorders.
- Symptoms include memory loss, impaired thinking, orientation issues, personality changes, and difficulties with language.
- Dementia is classified based on its underlying cause such as Alzheimer's, vascular, or Lewy body dementia.
-
Complex eating disorder characterized by obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image
Anorexia nervosa is typically characterized by
voluntary restriction of food intake ,distorted body image and fear of gaining weight
Premenstrual Syndrome – Recent Guidelines
Premenstrual Syndrome & Premenstrual Dysphoric Disorder
Incidence
80% of women have atleast one physical or psychiatric symptom during luteal phase
PMS -12-15%
PMDD – 1.3-5.3%
Abstract of depression assessment:
- How to assess
- Differential diagnosis for physiologic causes vs. psychological
- Rating scales
*There are notes provided in some slides
This document discusses the potential role of neuromodulation, specifically repetitive transcranial magnetic stimulation (rTMS), in the treatment of anorexia nervosa (AN). AN is characterized by abnormalities in brain regions involved in reward processing, decision making, and interoception. Preliminary evidence suggests rTMS targeting the dorsolateral prefrontal cortex may improve core AN symptoms, mood, and self-regulation. Several small studies and case reports provide initial support that rTMS is a safe, tolerable and may have therapeutic potential for AN, but more rigorous randomized controlled trials are still needed.
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
The document discusses depression, including its definition, epidemiology, prevalence in India, etiology, risk factors, physical illnesses associated with it, and treatment options. It notes that depression is a common mental disorder characterized by depressed mood and loss of interest, and that globally over 350 million people suffer from it. Treatment includes lifestyle changes, psychotherapy, pharmacotherapy using antidepressants like SSRIs, SNRIs, and TCAs, and other options such as transcranial magnetic stimulation.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome that affects 3-8% of women, causing severe mood changes, anxiety, and impairment in functioning during the luteal phase of the menstrual cycle each month. While the exact causes are unknown, it likely involves an interaction between fluctuating hormone levels and central neurotransmitters like serotonin. Selective Serotonin Reuptake Inhibitors (SSRIs) are effective treatments for PMDD symptoms, suggesting serotonin involvement, though their mechanism of action is complex and not solely due to serotonin reuptake inhibition. PMDD diagnosis requires prospective tracking of symptoms and exclusion of other conditions.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
This document discusses psychiatric disorders in pregnant and lactating women. It provides information on how pregnancy can impact mental health and psychiatric disorders. Key points include how psychiatric disorders and medications can affect pregnancy and the fetus. It emphasizes the importance of screening and predicting mental health issues during pregnancy and postpartum. The document also discusses managing different mental disorders throughout pregnancy, delivery, and lactation.
Huntington's disease is an inherited, progressive brain disorder that causes uncontrolled movements, emotional issues, and loss of thinking abilities. It is caused by a defective gene that is inherited from a parent. Early symptoms vary but may include mood swings, personality changes, and abnormal body movements. Currently there is no cure, but medications and therapies can help manage symptoms. The condition steadily worsens over time and is ultimately fatal.
Premenstrual syndrome (PMS) is characterized by physical, psychological, and behavioral symptoms that recur monthly before menstruation. Nearly 200 symptoms have been associated with PMS. Severe symptoms occur in 3-5% of menstruating women. Genetics play a role, as concordance is higher in identical twins. Common symptoms include fatigue, irritability, mood changes, and physical issues like breast tenderness and bloating. Prospective daily tracking of symptoms is important to differentiate PMS from premenstrual dysphoric disorder (PMDD) or other conditions. Treatments include oral contraceptives, vitamin B6, antidepressants, and lifestyle changes. Placebo-controlled trials are needed to properly
PMS affects 40% of women and causes psychological and physical symptoms related to the menstrual cycle. The exact cause is unknown but likely involves sensitivity to hormone fluctuations. Diagnosis requires tracking symptoms over two cycles which improve after menstruation. Treatment depends on severity but may include lifestyle changes, SSRIs, COCPs, or suppressing ovulation. CBT and some supplements like Vitex and calcium can also help reduce symptoms.
"Management of Premenstrual Tension (PMT)"
PMT (Premenstrual Tension) or PMDD (Premenstrual Dysphoric Disorder) is common problem.
Its impact on women's lives, family life in big way emphasizing the need for effective management.
Mood disorders:major depressive and bipolar disorderNandu Krishna J
a basic description about mood disorders mainly MDD and bipolar disorder. Can be made useful in presentations and theory exams. Subject was imbibed from different presentations and DSM IV manual. Thanks for viewing.
Premenstrual syndrome is a combination of psychological and physical symptoms that begin during the luteal phase of menstrual life.
This presentation consists of concise content for PMS required for final year BPT students. I hope this helps you to clear your concepts for the same. Thank you for your time.
National Prize of Applied Sciences nominee Dr. Jorge Lolas Talhami and his research on “cyclical hysterotoxemia”. Featuring: Dr. Enrique Vazquez-Vera - MD, FACOG; Dr. Jorge Lolas Talhami; Amanda Parodi; and Yusnaiberth Rivero De Detraux.
Content presented by Dr. Enrique Vazquez-Vera - MD, FACOG at the 2015 NAPMDD National Conference 8/9/2015.
View the session video at: http://napmdd.org/denver2015nc/session-03.html
Become a member of NAPMDD at:
http://napmdd.org/join
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
This document discusses depression, including its definition, statistics, types, causes, consequences, role of neurotransmitters, treatment options like medication and cognitive behavioral therapy. It defines depression and differentiates it from normal sadness. It covers diagnostic criteria, risk factors, and treatments including antidepressant medications, electroconvulsive therapy, light therapy, and cognitive behavioral therapy. Relapse prevention and the importance of continued treatment are also discussed.
Depression is underrecognized and undertreated in older adults. It is not a normal part of aging and can worsen medical illnesses. Symptoms include depressed mood, loss of interest, changes in appetite, insomnia, fatigue, guilt, and suicidal thoughts. Depression is diagnosed if five or more symptoms are present for two weeks. Treatment involves pharmacotherapy such as SSRIs or SNRIs for at least six months, psychotherapy like CBT, and other somatic therapies for severe cases. Untreated depression can have serious consequences so screening and treatment is important for older adults.
Major depression is characterized by depressed mood and loss of interest or pleasure that lasts at least two weeks. About 15% of people experience major depression in their lifetime. Females experience depression twice as often as males. Depression has genetic, biological, psychological, and social causes. Treatment involves psychotherapy, antidepressant medication, electroconvulsive therapy, or light therapy. Nursing care focuses on safety, support, and education to prevent suicide and promote recovery.
A 42-year-old man is experiencing a recurrent major depressive episode. He had previously responded well to treatment with imipramine but did not tolerate the anticholinergic side effects. Given his history of responding well to antidepressants and preference to avoid side effects, an SSRI with fewer anticholinergic effects would be a suitable first-line treatment option for this episode. Close monitoring would also be important given his risk of recurrence.
This document defines and describes various mood disorders. It outlines seven theories of etiology of mood disorders including genetic, biochemical, biologic, psychodynamic, behavioral, cognitive, and environmental theories. It then describes different types of depressive disorders like transient depression, mild depression, moderate depression, premenstrual dysphoric disorder, and severe depression. It also outlines types of bipolar disorders like bipolar mixed, bipolar depressed, bipolar manic, and cyclothymic disorder. Risk factors, signs and symptoms, diagnostic criteria, and treatments are discussed for various mood disorders.
This document discusses medically unexplained physical symptoms (MUPS) and somatic symptom disorder. It defines MUPS as physical symptoms that exist without objective medical findings or explanations. Somatic symptom disorder is characterized by physical symptoms caused by psychological or emotional distress. The document reviews the epidemiology, risk factors, clinical features, diagnostic criteria, cultural influences, and approaches for evaluating and treating patients with somatic symptom disorder.
The document describes a 31-year-old woman who presents with premenstrual syndrome (PMS) characterized by emotional and physical symptoms in the week before her period, including mood swings, hot flashes, breast tenderness, and weight gain. Her symptoms resolve after the start of her menstrual bleeding. The document discusses diagnostic criteria and treatments for PMS and premenstrual dysphoric disorder, including lifestyle changes, cognitive behavioral therapy, and antidepressants like SSRIs.
This document defines premenstrual syndrome as the occurrence of cyclical somatic, psychological, and emotional symptoms that occur in the luteal phase of the menstrual cycle and resolve when menstruation begins. It estimates that almost all women experience some symptoms, while 5% have severe symptoms. The causes are unknown but may involve hormonal fluctuations or low serotonin levels. Common symptoms include mood changes, cognitive issues, pain, and disruptions to daily life. Diagnosis involves tracking symptoms over multiple cycles. Management options range from lifestyle changes to various supplements, medications, and in rare cases, surgery. Assessing treatment effectiveness is difficult due to high placebo response rates.
Prememenustrual dysphoric disorder and post menopausal syndromePavan kulkarni
Premenstrual Dysphoric Disorder (PMDD) and Post Menopausal Syndrome are discussed. PMDD is characterized by severe depression, tension and irritability before menstruation. Hormonal fluctuations are believed to play a role through effects on brain chemistry. Diagnosis involves tracking symptoms. SSRIs are effective treatments. Post Menopause brings risks of vasomotor symptoms, urogenital atrophy, osteoporosis and psychological issues due to declining estrogen levels. Hormone replacement therapy can help manage many symptoms. Lifestyle changes and nutritional supplements also provide benefits.
This document provides information on postpartum psychiatric complications. It begins with an introduction to postpartum psychiatric disorders including classification into postpartum blues, depression, and psychosis. It then discusses risk factors, signs and symptoms, and management. Key points include that postpartum depression affects approximately 13% of women, risk factors include a history of depression and complications during pregnancy, and treatment involves counseling, antidepressants, and monitoring for suicidal ideation.
This document discusses the recognition and treatment of depression. Major depression is one of the leading causes of disability worldwide and is estimated to become the second largest contributor to disability-adjusted life years lost globally by 2020. Depression is underdiagnosed and undertreated. It is a chronic illness with a high risk of recurrence. Treatment involves medication, psychotherapy, and lifestyle changes, with careful monitoring of patients over time.
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
Similar to Premenstrual changes lugansk state-medical-university (20)
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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1. Premenstrual Changes
(PMCs)
Lugansk State Medical University
Block 50 years, Of lugansk defence, 1.
.Lugansk - 91045, Ukraine
kanc@lsmuedu.com / : emailinfo@lsmuedu.com
- Official websitehttp://www.lsmuedu.com
Telephone : +38-091-9484-428 / 091-9425-888 / 064-2630-263
Fax: +380 (642) 53-20-36
2. • PMCs (Premenstrual Changes) are a budding
issue having both the psychiatry and gynecology-
related symptoms with adverse social
consequences.
3. • PMCs (Premenstrual Changes) are a common
cyclic affective disorder of young and middle-aged
occuring in the luteal phase.
• PMCs range from mild mood fluctuations, called
Premenstrual Syndrome (PMS) to severe mental
and physical disturbances, called Premenstrual
Dysphoric Disorder (PMDD).
• The exact aetiology of PMCs is largely under-
explored.
• Its diagnosis and management are often difficult.
4. Incidence
• Premenstrual syndrome and premenstrual dysphoric
disorder are diagnoses of exclusion; therefore,
alternative explanations for symptoms must be
considered before either diagnosis is made
• Milder symptoms are believed to occur in about 30%
to 80% of reproductive-age women, while severe
symptoms are estimated to occur in 3% to 5% of
menstruating women.
6. • Cerebral serotonin neurotransmitter system (5-HTs) is an
important component, involved in a large number of
psychiatric illnesses where the affect is disturbed.
• PMDD is another extreme reflection of the affective
disturbances. Therefore, it is interesting to note whether 5-
HTs play any role in the development of PMCs. Studies
have shown that post-synaptic serotonergic response
possibly is disturbed during the late-luteal-premenstrual
phase of the MC or even throughout the cycle in those who
have severe vulnerability trait
• Though the gonadal hormone (oestrogen and
progesterone)-induced modulation of 5-HTs is a known fact
at the backdrop of schizophrenia
• , in PMCs, differential effects in the cerebral 5-HTs due to
differential hormonal changes in the MC
7. Diagnosis
• Screening of patients could easily be done by
asking the patients to maintain regular
menstrual diary for at least two consecutive
cycles to note the target symptoms.
8.
9. Diagnostic Criteria for Premenstrual
Syndrome
• National Institute of Mental Health
• A 30% increase in the intensity of symptoms of premenstrual
syndrome (measured using a standardized instrument) from cycle
days 5 to 10 as compared with the six-day interval before the onset
of menses and Documentation of these changes in a daily symptom
diary for at least two consecutive cycles
• University of California at San Diego
• At least one of the following affective and somatic symptoms during
the five days before menses in each of the three previous cycles:
– Affective symptoms: depression, angry outbursts, irritability, anxiety, confusion,
social withdrawal
– Somatic symptoms: breast tenderness, abdominal bloating, headache, swelling
of extremities
– Symptoms relieved from days 4 through 13 of the menstrual cycle
10.
11. Common Symptoms of PMS
Women with PMS
Symptom Showing Symptoms (%)
Behavioral
Fatigue 92
Irritability 91
Labile mood with alternating
sadness and anger 81
Depression 80
Oversensitivity 69
Crying spells 65
Social withdrawal 65
Forgetfulness 56
Difficulty concentrating 47
12. Common Symptoms of PMS
((Continued
Physical
Abdominal bloating 90
Breast tenderness 85
Acne 71
Appetite changes and
food cravings 70
Swelling of the extremities 67
Headache 60
Gastrointestinal upset 48
13. Differences Between PMS and PMDD
Diagnostic criteria Tenth Revision of Diagnostic and
the International Statistical Manual
Classification of of Mental
Disease (ICD-10) Disorders, 4th ed.
(DSM-IV)
Providers using Obstetrician/gynec Psychiatrists, other
these criteria ologists, primary mental health care
care physicians providers
Number of One 5 of 11 symptoms
symptoms
required
Functional Not required Interference with
impairment social or role
functioning
required
Prospective Not required Prospective
charting of daily charting of
symptoms symptoms
required for two
cycles
14. Patterns of PMS
• Premenstrual symptoms can begin at ovulation with
gradual worsening of symptoms during the luteal
phase (pattern 1).
• PMS can begin during the second week of the luteal
phase (pattern 2).
• Some women experience a brief, time-limited episode
of symptoms at ovulation, followed by symptom-free
days and a recurrence of premenstrual symptoms late
in the luteal phase (pattern 3).
• The most severely affected women have symptoms
that at ovulation worsen across the luteal phase and
remit only after menses cease (pattern 4). These
women describe having only one week a month that is
symptom-free.
16. Differential Diagnosis
((Continued
Premenstrual exacerbation Psychosocial spectrum
• Of psychiatric disorders • Past history of sexual abuse
• Of seizure disorders • Past, present, or current
• Of endocrine disorders domestic violence
• Of cancer
• Of systemic lupus
erythematosus
• Of anemia
• Of endometriosis
17. Management protocol
• Management of PMCs is often extremely
difficult
• Patients qualified for PMCs could be rated for
the symptoms severity under the three-point
scale:
mild, moderate and severe.
• According to the symptom rating, the
guidelines for the management of PMCs could
be adopted as follows
18. • A. Life style modification including counseling
or behavioral psychotherapy for coping up
with the symptoms when the symptoms are
mild, and
• B. Pharmacotherapy when the symptoms,
although mild, are not been tackled by simple
life style modification or counseling and
psychotherapy or the symptoms are moderate
to severe and incapacitating.
19. Strategies to cope up PMCs by
:modifying life styles
• Doctors often prescribe/advice the followings for their
patients with mild PMCs as the first-line of
management:
• Prohibition for caffeine, refined sugars, and crude
salt intake,
• Avoiding alcohol and related beverages
• Regular exercise, especially isotonic
• Increase carbohydrate intake in the diet , and
• Cognitive-behavioral psychotherapy, if required
20. • Though the role of these are quite under
tested, the reasons for such age-old
prescriptions are probably continuing due to
the other benefits and safety
• . If these are found to be ineffective or
inadequate, or the symptoms are severe,
pharmacotherapy remains the mainstay of the
treatment
21. Strategies for opting for the
pharamacological agents
• Vitamins and minerals as dietary
supplements,
• Psychopharmacologiucal drugs, and
• Hormonal agents:
• Vitamins and minerals
24. Progesterone
• The role of Progesterone in the treatment of PMS probably arose
from the theory that the syndrome is caused from a lack of
progesterone which was popular back in the 1950s up until the
1980s.
• Treatment with high doses of "natural" progesterone vaginally
became popular in the 1970s after the publication of a large number
of case reports in the lay press,
• none of which had any true control groups. Since then, several
randomised-controlled trials have failed to show any benefit from
topical or oral micronized progesterone over placebo Topical
progesterone preparations are also expensive. Given the lack of
efficacy and the expense of the product, Progesterone can not be
recommended as a treatment of PMS.
25. Pyridoxine vitamin B(6)
• Pyridoxine or vitamin B6 is the most widely used
supplement used to treat PMS.
• It has been proposed that vitamin B6 may help to
correct a "deficiency" in the hypothalamic pituitary
axis. Vitamin B6 is a cofactor in the synthesis of
tryptophan and tyrosine, which are the precursors
of serotonin and dopamine respectively.
Theoretically, low levels of vitamin B6 may lead to
high levels of prolactin which in turn could underlay
the edema and psychological symptoms associated
with PMS.
26. • it would appear that there is very limited evidencve
to support the generalized use of vitamin B6 for the
treatment of PMS.
• Vitamin B6 can also cause significant toxicity and
unpleasant side effects. It can produce a
progressive sensory ataxia taken at doses as low
as 500 mg. a day and can also cause a number of
gastrointestinal side effects, particularly nausea.
• Consequently, given the lack of clear scientific
evidence for its effectiveness, and the associated
risks of treatment, vitamin B6 can not generally be
recommended as a treatment for PMS.
27. Bromocriptine
• Another theory that was popular in the 1970s was
that PMS was caused by increased levels of, or an
increased sensitivity to, Prolactin.
• Bromocriptine is expensive and has a number of
side effects. Consequently its use can not be
recommended for the general treatment of PMS
• One exception is severe cyclical mastalgia for which
Bromocriptine may be effective.
28. Combination Oral contraceptives
• Combination oral contraceptives are also widely
used to treat PMS. Despite their popularity,
• Consequently, the lack of scientific evidence for
their effectiveness along with the associated
expense and potential risks,
• OCPs can not be recommended for the treatment of
PMS
30. Diet
• Dietary recommendations are commonly
recommended to help alleviate the physical and
psychological symptoms of PMS.
• The most common dietary recommendations are to
restrict sugar
and increase the consumption of complex
carbohydrates.during the latter half of their cycle
may help alleviate some of the psychological
symptoms of PMS
31. Aerobic exercise
• Women who have PMS are often
encouraged to increase their activity
level. It has been hypothesised that
exercise; particularly aerobic varieties
increase endorphin levels, which in turn
improves mood
• , it would seem reasonable to
recommend an aerobic exercise
program to alleviate PMS symptoms
32. Psychological approaches
• various psychological approaches including
instruction on
relaxation techniques,
cognitive behavioural strategies
and information giving may all help relieve PMS
symptoms.
33. Magnesium
• Studies have found that women who suffer from PMS have
lower levels of erythrocyte and monocellular magnesium
during their menstrual cycles than women who do not have
PMS.
• Accordingly, magnesium supplementation has been used
as a potential therapy.
• It reported less fluid retention .Menstrual cramps, irritability
and fatigue, but They did not have any improvement in
mood, cramping or food cravings
• Magnesium is considered safe at doses up to 483 mg. per
day in healthy adults. It must be used with caution,
however, in people with significant heart and renal disease
34. Evening Primrose Oil
• Evening Primrose Oil is used extensively to
alleviate PMS symptoms. EPO contains two
essential fatty acids: linoleic and gamma linoleic
acids. It has been hypothesised that women with
PMS are deficient in gamma linoleic acid which is
necessary for prostaglandin
• EPO may be of some benefit to those women with
cyclical mastalgia but is probably of limited if any
benefit to women who have significant mood and
cognitive symptoms
35. Vitamin E
• Vitamin E has been used to treat PMS and general
breast tenderness. There have been only a few
studies that have addressed this issue.
36. Spironolactone
• Diuretics have been used to treat the fluid retention
associated with PMS for over 50 years.
• Despite their wide spread use, there is no evidence
that the thiazide diuretics are of any benefit. These
medications are also associated with significant
side effects including hypokalemia, secondary
aldosteronism and cyclical edema. Consequently
they can not be recommended for the treatment of
PMS.
37. Non Steroidal Anti-inflammatories
• There is some evidence that NSAIDS given during
the luteal phase does help relieve the physical and
affective symptoms of PMS. Mefenamic acid (500
mg. T.I.D.), Naproxen
when administered during the luteal phase of the
cycle.
38. Ovulation Suppression
• The use of Danazol and Gonadotrophin Releasing Hormone Agonists
to suppress ovulation have been shown to reduce the symptoms of
PMS.
• The significant side effects associated with these treatments
however, makes them generally unacceptable for use in Primary
Care..
• It is important to appreciate that the synthetic hormones vary in their
chemical composition and effects from each other and the natural
products. Consequently differences in chemical compositions, even
relatively subtle ones, may underly the differences in response to
various hormonal treatments including hormonal regimes that have
been found to be effective and the OCPs and natural progesterone
which have not been found to be effective
40. Calcium
• findings provide good evidence for the
effectiveness of calcium carbonate as a treatment
for PMS.
• Calcium is also relatively inexpensive and plays an
important role in the prevention of osteoporosis,
therefore it is recommended for the treatment of
PMS.
41. Selective Serotonin Reuptake Inhibitors
• PMS has been linked with dysfunctional serotonin metabolism and
there is experimental evidence that hormonal fluctuations do affect
central serotonin levels
• strongly support the effectiveness of SSRIs in the treatment of PMS.
Interestingly,
• It was found no difference in the effectiveness of continuous
compared to intermittent therapy during the luteal phase.
• The doses used for PMS also tend to be lower than that used for
depression.
• Consequently the incidence of side effects tend to be lower as well
The use of the SSRIs is not with out its drawbacks. A host of side
effects have been reported including headache, nervousness,
insomnia, drowsiness, fatigue, sexual dysfunction and
gastrointestinal complaints.
• The SSRIs are also relatively expensive
• Nonetheless given their proven efficacy, they are recommended,
particularly for women with severe affective symptoms for whom
other measures have not been effective.
42. • The ACOG recommends SSRIs as initial drug therapy in
women with severe PMS and PMDD. [Evidence level C,
expert/consensus guidelines]
• Common side effects of SSRIs include insomnia,
drowsiness, fatigue, nausea, nervousness, headache, mild
tremor, and sexual dysfunction.
• Use of the lowest effective dosage can minimize side
effects. Morning dosing can minimize insomnia.
• In general, 20 mg of fluoxetine or 50 mg of sertraline taken
in the morning is best tolerated and sufficient to improve
symptoms.
• Benefit has also been demonstrated for the continuous
administration of citalopram (Celexa).
• alleviating physical and behavioral symptoms, with similar
efficacy for continuous and intermittent
43. SSRIs Dos Recemmendations Side
age for use effects
Fluoxetine to 10 First-choice agents for Insomnia,
((Sarafem 20 the treatment of PMDD; drowsiness
mg at present, only , fatigue,
per fluoxetine is labeled for nausea,
day this indication. nervousne
Sertraline to 50 Clearly effective in ss,
((Zoloft 150 alleviating behavioral headache,
mg and physical symptoms mild
per of PMS and PMDD tremor,
day For intermittent therapy, sexual
administer during luteal dysfunctio
Paroxetine to 10
phase (days before n
((Paxil 30
menses).
mg
per
day
44. NATURAL THERAPIES
• Following is a description of some of the more
commonly used herbal preparations used to
treat PMS. Our current knowledge about
these substances is largely based on
pharmacological and descriptive data, which
significantly limits our ability to draw
conclusions about their effectiveness and long
term safety.
45. Black Cohosh
• This herbal remedy is derived from the rhizome and root of the plant. Its action is
related to the binding of estrogens receptors and suppression of leutinizing
hormone although it is not thought to increase the risk for endometrial and breast
cancers. It has been rated as "possibly effective" for the treatment of pre-menstrual
discomfort. It is likely safe when taken in low doses (0.3 to 2 mg. T.I.D.) for less
than six months.
• Black Cohosh also contains Salicylic acid and consequently should not be taken
by people who should avoid aspirin or who are at risk of bleeding. Similarly, it
should be avoided in women in whom estrogen is contraindicated. Overdose of
Black Cohosh can cause nausea, vomiting, dizziness, visual disturbance, and
decreased heart and respiration rates
Borage Seed oil
• Borage seed oil contains 26% gamma linoleic acid and is used as a replacement
for evening primrose oil. It is "likely safe" if used orally as directed. Gamma linoleic
acid can prolong bleeding time and therefore should be used with caution in people
at risk of serious bleeding including those who are taking other medications and
herbal products that can prolong bleeding times.
46. Dandelion
• Dandelion is used for a variety of medicinal purposes. It has been shown to have
mild diuretic and anti-inflammatory properties in animal studies. It has been rated
as "possibly effective" for promoting diuresis and may be of some benefit in treating
the fluid retention associated with PMS.
• Theoretically dandelion can have hypoglycemic effects and therefore should be
used with caution in individuals taking diabetic medications
• . Individuals who have environmental allergies to members of the Asteracae family,
which includes ragweed, chrysanthemums, marigolds and daisies, should also
avoid this herb
Dong Quai
• Dong Quai is a commonly used herb used for a variety of gynecological symptoms
including PMS. It contains a number of different constituents, which are thought to
have vasodilating, antispasmodic, and anti platelet activities.
• Dong Quai does have carcinogenic and mutagenic properties and can cause
severe photodermatits especially when used in large amounts.
• It is rated as "possibly unsafe" by the Natural Medicine Comprehensive Database.
• It may also interact with several medications and other herbal remedies
48. • How do we organise the above information into a
practical concise set of guidelines for Family
Physicians?
• The following recommendations are based on
interpretation of the strength of evidence for
effectiveness of the various therapies, as well as the
potential costs, adverse effects and long term risks
involved.
• The nature of the symptoms was also taken into
account. Johnson describes a similar but not
identical approach in her very comprehensive review
article on the subject
49.
50. Summary of Management Guidelines
• All women with PMS or PMDD
• Nonpharmacologic treatment: education, supportive therapy, rest, exercise, dietary
modifications
• Symptom diary to identify times to implement treatment and to monitor
improvement of symptoms
• Treatment of specific physical symptoms
• Bloating: spironolactone (Aldactone)
• Headaches: nonprescription analgesic such as acetaminophen, ibuprofen, or
naproxen sodium (Anaprox; also, nonprescription Aleve)
• Fatigue and insomnia: instruction on good sleep hygiene and caffeine restriction
• Breast tenderness: vitamin E, evening primrose oil, luteal-phase spironolactone, or
danazol (Danocrine)
• Treatment of psychologic symptoms
• For symptoms of PMDD, continuous or intermittent therapy with an SSRI
• Treatment failure
• Hormonal therapy to manipulate menstrual cycle