MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.
Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada.
Acta Psychiatr Scand. 2017 Nov;136(5):473-482. doi: 10.1111/acps.12797. Epub 2017 Aug 28.
The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown.
We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD.
MATERIALS & METHODS: A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria.
Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001).
The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD.
The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.
经前期烦躁障碍（PMDD）合并于双相障碍（BD）女性中的影响目前仍知之甚少。
我们比较了 PMDD 合并和不合并于 BD 的女性患者之间的疾病特征和女性特有的心理健康问题。
共有 1099 名参与系统性治疗增强计划治疗双相障碍（STEP-BD）的 BD 女性患者参与了本研究。精神科诊断和疾病特征使用迷你国际神经精神访谈进行评估。女性特有的心理健康使用为 STEP-BD 开发的自我报告问卷进行评估。PMDD 诊断基于 DSM-5 标准。
PMDD 合并 BD 的女性患者有更早的双相障碍发病（P < 0.001）和更高的快速循环发生率（P = 0.039），以及更多的过去一年轻躁狂/躁狂（P = 0.003）和终生/过去一年的抑郁发作（P < 0.05）。PMDD 合并还与惊恐障碍、创伤后应激障碍、广泛性焦虑障碍、贪食症、物质滥用和成人注意缺陷障碍的更高比例相关（均 P < 0.05）。PMDD 合并的女性患者，BD 发病和初潮年龄之间的差距更小（P = 0.003）。PMDD 合并的女性患者在围产期和服用口服避孕药时报告有更严重的情绪症状（P < 0.001）。
本研究结果与研究一致，表明对内源性激素的敏感性可能影响 BD 的发病和临床病程。
PMDD 与 BD 的共病与更差的临床结局和增加的疾病负担相关。
