Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
University of Marburg, Marburg, Germany.
Psychol Med. 2020 Apr;50(6):964-972. doi: 10.1017/S0033291719000849. Epub 2019 Apr 23.
Premenstrual dysphoric disorder (PMDD) is a new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis characterized by the cyclical emergence of emotional and physical symptoms in the luteal phase of the menstrual cycle, with symptom remission in the follicular phase. Converging evidence highlights the possibility of distinct subtypes of PMDD with unique pathophysiologies, but temporal subgroups have yet to be explored in a systematic way.
In the current work, we use group-based trajectory modeling to identify unique trajectory subgroups of core emotional and total PMDD symptoms across the perimenstrual frame (days -14 to +9, where day 0 is menstrual onset) in a sample of 74 individuals prospectively diagnosed with DSM-5 PMDD.
For the total daily symptom score, the best-fitting model was comprised of three groups: a group demonstrating moderate symptoms only in the premenstrual week (65%), a group demonstrating severe symptoms across the full 2 weeks of the luteal phase (17.5%), and a group demonstrating severe symptoms in the premenstrual week that were slow to resolve in the follicular phase (17.5%).
These trajectory groups are discussed in the context of the latest work on the pathophysiology of PMDD. Experimental work is needed to test for the presence of possible pathophysiologic differences in trajectory groups, and whether unique treatment approaches are needed.
经前期烦躁障碍（PMDD）是《精神障碍诊断与统计手册》第 5 版（DSM-5）中的一个新诊断，其特征为周期性出现情绪和身体症状，出现在月经周期的黄体期，在卵泡期症状缓解。越来越多的证据表明，PMDD 可能存在不同的亚型，具有独特的病理生理学，但尚未系统地探讨时间亚组。
在目前的工作中，我们使用基于群组的轨迹建模，在一个前瞻性诊断为 DSM-5 PMDD 的 74 名个体样本中，在经前期框架（-14 天至+9 天，其中 0 天为月经来潮）中识别核心情绪和总 PMDD 症状的独特轨迹亚组。
对于总日症状评分，最佳拟合模型由三组组成：一组仅在经前期表现为中度症状（65%），一组在整个黄体期 2 周均表现为重度症状（17.5%），一组在经前期表现为重度症状，在卵泡期缓慢缓解（17.5%）。
这些轨迹组是在 PMDD 病理生理学的最新研究的背景下讨论的。需要进行实验工作，以测试轨迹组是否存在可能的病理生理差异，以及是否需要独特的治疗方法。
