Steiner M
St. Joseph's Hospital, McMaster Psychiatric Unit, McMaster University, Hamilton, Ontario, Canada.
Annu Rev Med. 1997;48:447-55. doi: 10.1146/annurev.med.48.1.447.
The recent inclusion of research criteria for premenstrual dysphoric disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders should help physicians recognize women with symptoms of irritability, tension, dysphoria, and lability of mood that seriously interfere with their lifestyle. Premenstrual dysphoric disorder can be differentiated from premenstrual syndrome, which is primarily reserved for milder physical symptoms and minor mood changes. The use of criteria from the Diagnostic and Statistical Manual in conjunction with prospective daily charting for at least two menstrual cycles is now accepted as common practice in confirming the diagnosis. Treatment options range from the conservative (lifestyle and stress management) to treatment with psychotropic medications and hormonal or surgical interventions to eliminate ovulation for the more extreme cases. Results from several randomized, placebo-controlled trials have clearly demonstrated that selective serotonin reuptake inhibitors, as well as medical or surgical oophorectomy, are effective in treating premenstrual dysphoric disorder. Taken together, these data indicate that treatment may be accomplished by either eliminating the hormonal trigger or by reversing the sensitivity of the serotonergic system.
《精神疾病诊断与统计手册》第四版最近纳入了经前烦躁障碍的研究标准，这应有助于医生识别那些出现易怒、紧张、烦躁不安以及情绪不稳定症状，且这些症状严重干扰其生活方式的女性。经前烦躁障碍可与经前综合征相区分，经前综合征主要用于描述较轻微的身体症状和较小的情绪变化。目前，结合使用《诊断与统计手册》中的标准以及至少两个月经周期的前瞻性日常记录来确诊已成为普遍做法。治疗方案范围广泛，从保守治疗（生活方式和压力管理）到使用精神药物治疗，以及针对更极端病例采用激素或手术干预以消除排卵。多项随机、安慰剂对照试验的结果已清楚表明，选择性5-羟色胺再摄取抑制剂以及药物或手术卵巢切除术对治疗经前烦躁障碍有效。综合来看，这些数据表明，治疗可通过消除激素触发因素或逆转血清素能系统的敏感性来实现。
