Archives of Women's Mental Health最新文献

Purpose

This retrospective study aimed to investigate the association between premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and the presence of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in adolescent females. While PMS and PMDD are well-studied in the general population, limited research exists on their prevalence and impact in adolescent females with ASD or ADHD.

Methods

Retrospective data collection was conducted using electronic medical records, covering 290 patients aged 10–19 years. PMS severity, depressive symptoms, and autistic tendencies were assessed using standardized tools, including the Quick Inventory of Depressive Symptomatology (QIDS) for depressive symptoms, Autism-Spectrum Quotient (AQ) for autistic tendencies, and a PMDD assessment scale for PMS severity.

Results

The results revealed a significant association between moderate to severe PMS and ADHD (odds ratio [OR]: 2.43) as well as comorbid ASD + ADHD (OR: 3.27). In contrast, ASD alone did not exhibit a significant link to PMS severity.

Conclusion

These findings highlight the heightened vulnerability of females with ADHD or comorbid ASD + ADHD to premenstrual psychological distress, emphasizing the importance of early detection and intervention. The study underscores the need for tailored treatment strategies addressing the unique challenges faced by this population.

Purpose

Understanding mechanism of action of effective agents for Premenstrual Dysphoric Disorder (PMDD) is necessary to advance care of these patients. It can be successfully treated with fluoxetine, but its efficacy with intermittent use is difficult to understand because of documented delays in the onset of antidepressant action of this drug.

Methods

Targeted review of the literature is used to examine the hypothesis that fluoxetine’s inhibiton of CYP3A4, which is needed to metabolize estrogen, underlies its utility when dosed intermittently.

Results

We propose that fluoxetine slows the degradation of estrogen the late luteal phase, thereby increasing its levels and reducing the PMDD symptoms that typically are associated with alterations in hormone concentrations. The hypothesis can be tested by using a potent CYP3A4 inhibitor that has no antidepressant action. Such agents include the antiviral drugs ritonavir and cobicistat which are potent CYP3A4 inhibitors and are currently being used to boost the levels of other antivirals in the treatment of human immunodeficiency virus (HIV). Prospective studies with women with PMDD in this population before and after initiation of CYP3A4 inhibiting anti-retrovirals would help clarify this question.

Conclusion

Confirmation of this mechanism may open the door to non-SRI treatments for women that do not tolerate SRI agents.

This letter provides recommendations regarding the study titled “Psychiatric disorders, impulsivity and borderline personality in patients with polycystic ovary syndrome” published by Husni et al. on May 6, 2025.

Purpose

Maternal anxiety, depression, and cognitive changes during pregnancy are recognized as significant public health issues. While previous research has primarily focused on singleton pregnancies, little is known about how twin pregnancies impact maternal mental health and cognitive function. This prospective study aimed to compare anxiety, depression, and cognitive function between women with twin and singleton pregnancies.

Methods

A total of 160 pregnant women were recruited, including 104 with singleton and 56 with twin pregnancies. Anxiety was assessed using the State-Trait Anxiety Inventory Scale (STAI-S), depression using the Edinburgh Postnatal Depression Scale (EPDS), and cognitive function using the Montreal Cognitive Assessment (MOCA) test.

Results

Women with twin pregnancies had significantly higher anxiety levels and a higher rate of severe anxiety, with over 50% scoring in the severe anxiety range. Their mean cognitive function scores were significantly lower compared to women with singleton pregnancies. However, depression scores were similar between the two groups. These differences in anxiety and cognitive function remained significant after adjusting for maternal age, BMI, use of psychiatric medications, education level, nulliparity, pregnancy complications, and multifetal gestation.

Conclusions

Women with twin pregnancies experience greater psychological burden and cognitive decline compared to those with singleton pregnancies. Further research is necessary to explore the long-term effects of these outcomes and to develop interventions aimed at improving mental health and cognitive function in this population.

Purpose

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for mood disorders in pregnancy, though studies regarding effects on fetal behavior are conflicting. Previous studies have suggested that fetuses exposed to these medications in the third trimester may have decreased fetal heart rate variability. Since changes in variability may affect the interpretation of antenatal testing, clinicians should be aware of those medications that may impair effective testing.

Methods

A retrospective observational cohort study was performed to compare nonstress test (NST) parameters of fetuses exposed to SSRIs with unexposed fetuses at 36 weeks gestation. Subjects were excluded if they had multiple gestations, fetal anomalies including growth restriction, illicit substance use or use of other psychotropic medications. NSTs were compared for fetal baseline heart rate, variability, time to reactivity, number of accelerations over time, and number of fetal movements over time.

Results

Of 219 participants, 12 were taking an SSRI/SNRI at the time of their 36-week NST. There were no significant differences in demographics or indications for NST between groups. NSTs were reactive in 92% of those taking an SSRI/SNRI and in 97% of those not taking an SSRI/SNRI. Time to reactivity [8.6 min vs. 12.5 min], baseline heart rate [142 bpm vs. 139 bpm], and heart rate variability [12.1 bpm vs. 11.7 bpm] were all similar between the two groups.

Conclusion

Though limited by sample size, lack of pharmacologic data and potential confounding by indication, the study suggests SSRI use is not associated with any significant changes in NST. Clinicians should be reassured that NST assessment remains a useful means of determining fetal wellbeing in patients using these medications.