Psychoneuroendocrinology

Psychoneuroendocrinology is the clinical study of hormone fluctuations and their relationship to human behavior. It may be viewed from the perspective of psychiatry, where in certain mood disorders, there are associated neuroendocrine or hormonal changes. It may also be viewed from the perspective of endocrinology, where certain endocrine disorders can be associated with psychiatric illness. It is the blend of psychiatry and endocrinology.

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Disorders

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome affecting 3-8% of women in their reproductive years. PMDD mood disturbances are more severe than those of PMS. The most common symptom is irritability. Many women also report depressed mood, anxiety, or mood swings. These symptoms emerge one to two weeks preceding menses and resolve completely with the onset of menses. By definition, this mood disturbance results in marked social or occupational impairment, with its most prominent effects in interpersonal functioning. PMDD is a psychiatric diagnosis and is considered to be one of the affective disorders, classified in the DSM-IV-TR as "depressive disorder not otherwise specified." PMDD can be distinguished from other affective disorders primarily by the cyclical nature of the mood disturbance. Unlike other affective disorders, mood symptoms are only present for a specific period of time, during the luteal phase of the menstrual cycle. Additionally, these mood symptoms do not occur in the absence of a menstrual cycle, as during reproductive events such as pregnancy or menopause. ^[1]

Postpartum Depression (PPD)

Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness.

50 to 85% of women experience postpartum blues during the first few weeks after delivery. Given how common this type of mood disturbance is, it may be more accurate to consider the blues as a normal experience following childbirth rather than a psychiatric illness. Rather than feelings of sadness, women with the blues more commonly report mood lability, tearfulness, anxiety or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery.

Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman's life. Especially with milder cases, it may be difficult to detect postpartum depression because many of the symptoms used to diagnose depression (i.e., sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression. The Edinburgh Postnatal Depression Scale^[2] is a 10-item questionnaire that may be used to identify women who have PPD. On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raise concern and indicate a need for more thorough evaluation.

Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth. Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks. ^[3]

References