P-1475 - Differential Diagnosis of Menstrual Psychosis Versus Menstrual Exacerbation of Schizoaffective Disorder in the Context of Acculturation Difficulties: a Case Report

Abstract

Introduction:

The perimenstrual period is associated with increased psychiatric disturbances of both neurotic and psychotic nature. Menstrual psychotic disorder (MPD) is an uncommon condition, not universally accepted within the classifications of functional psychosis; its symptoms are not included under actual definitions of premenstrual syndrome (PMS). The MPD diagnosis requires specific features and excludes acute menstrual-related exacerbations of chronic mental conditions and menstrual mood-disorders.

Case description:

We present the prospective case study of a 24-year-old Chinese woman recently arrived in France following marriage, who was admitted on three occasions to an inpatient psychiatric service for symptoms of acute recurrent psychosis developed with the onset of menstrual flow. Each episode was characterized by acute onset with the menstrual bleeding, short duration with full recovery few days after. Pharmacotherapy was instaurated from the first episode (risperidone and other coadjuvant drugs).

Discussions:

This case illustrates the complexity of diagnosis in a person with recurrent presentation of psychotic symptoms associated with menses. In most of the MPD case-reports in literature, no serious psychosocial stress factor was mentioned; the use of psychotropic drugs was also considered inconclusive, successful treatment with hormone therapy being reported in several situations.

Although pre-existing psychiatric conditions may exacerbate in the perimenstrual period, the relationship between typical functional psychoses and MPD, and the phenomenology of this disorder needs to be clarified; case-studies may contribute to the recognition of MPD as a specific disease entity.