A Case of Menstrual Psychosis, an Under Recognized Diagnosis

Menstrual psychosis is a rare disorder that causes psychotic symptoms in conjunction with a patient’s menstrual cycle. We present a case of a 14-year-old girl who presents with such symptoms. Our patient presented with five days of somnolence, paranoia, and visual hallucinations soon after a diagnosis of streptococcal pharyngitis and being started on antimicrobial therapy. Her neurologic exam was significant for flat affect and psychomotor slowing. A thorough work-up consisting of brain MRI, EEG, LP, encephalopathy panel, along with metabolic, infectious, and inflammatory laboratory analysis was unremarkable, and she recovered without therapy about one week after symptom onset. Patient had recurrence and spontaneous resolution of her symptoms two more times over the next 10 months with repeat work-up negative; her family noted that the onset of her symptoms always seemed to coincide with the onset of her menses. She was started on combination oral contraceptive pills and has had no further recurrence of her symptoms since then.