Page 100 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Menstrual psychosis and treatment

exacerbation of various psychiatric symptoms. In addition, labile affect, irritability, and subjective reports of loosening
scientific data indicate that the risk of psychosis, mania, grip on reality. Collateral information ascertained by her
depression, suicide/suicide attempts, and alcohol use may husband noted worsening mood swings, irritability, and
increase during these phases in susceptible patients. 3 paranoia over the course of a few days. During the initial
Early observations noted a connection between psychiatric consult interview, the patient was irritable and
menstruation and psychological disorders, with menstrual displayed paranoia, accusing the team of recording the
mood disorder even being used as a defense in a filicide conversation and taking pictures of her to be used for an
case in 1827. Various forms of psychosis related to the undisclosed reason. Her husband reported that the patient
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menstrual cycle, such as premenstrual and catamenial thought people were following her and stealing her things
th
psychosis, were described in the 19 century. Researchers at home. She had also dusted the home for fingerprints. In
amassed cases related to all menstrual disorders, but the the emergency department, the patient denied everything
classification was based on presenting symptoms, as her husband stated, but she did report knowing she needed
opposed to the timing of onset. Krafft-Ebing significantly help before symptoms worsened, as they had in the past.
contributed literature in 1878 by describing 19 cases She reported very little sleep over the past few days before
and later introducing a temporal classification in his consulting us, being irritable and suspicious with her
1902 monograph “Psychosis Menstrualis.” Krafft-Ebing’s husband, typically acting “crazy” just before menstruation,
classification included menstrual developmental psychosis, then returning to baseline shortly after.
ovulation psychosis, and epochal menstrual psychosis, Notably, the patient had a recent involuntary admission
based on the temporal differentiation of these conditions. In to the inpatient psychiatric unit 2 weeks prior for similar
1914, Jolly revised this classification, emphasizing the stage psychotic symptoms of worsened severity, and that had
of reproductive life. Jolly’s revision included differences progressed over the preceding 2 weeks. During that previous
among the conditions in terms of their relationship with hospitalization, she presented with florid psychosis –
the phases of the menstrual cycle; for example, psychoses disorganized thinking, delusions, paranoia, and agitation.
that occur before menarche, at menarche, at menopause, Her delusions included believing her husband was
recurrent menstrual psychosis, and epochal cases were cheating, someone was trying to kill her family, everyone
included in this revision. 1 was a pedophile, and her children had devices implanted
Building on the work of Krafft-Ebing and Jolly, in their eyes. She was treated with olanzapine 10 mg daily
Brockington proposed a modified classification system for and responded rapidly, being discharged in <1 week. Her
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menstrual psychosis. Brockington’s new system categorizes reason for seeking voluntary treatment during this second
cases in two steps: first by their timing within the menstrual admission was to prevent symptoms from progressing
cycle and then by the reproductive epoch. According as they had leading to the first admission. Both the
to Brockington, menstrual psychosis has the following patient and her husband reported good compliance with
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characteristics: (a) acute onset, against a background olanzapine at home. Before each admission, her irritability,
of normality; (b) brief duration, with full recovery; agitation, paranoia, and delusional thoughts had worsened
(c) psychotic features: confusion, stupor, and mutism, significantly in the week preceding it, coinciding with
delusions, hallucinations, or a manic syndrome; and (d) a the premenstrual phase of her period. She believed all
circa-menstrual (approximately monthly) periodicity, in her symptoms were linked to her menstrual cycle and
rhythm with the menstrual cycle. 1 had worsened before her last admission, possibly due to

Research on menstrual-related psychosis remains cannabis and methylphenidate use, or due to psychosocial
limited, with most studies consisting of case reports and stressors including raising two small children and
series. This case adds valuable data to the developing intermarital conflicts. She denied any safety concerns at
body of knowledge in this area. Specifically, it emphasizes home. Urine drug screen on first admission was positive
the importance of antipsychotics for achieving initial for cannabis but negative for amphetamines.
stabilization and suggests the potential of hormone-based The inpatient psychiatric evaluation on second
contraceptives as a preventive measure. admission was notable for a long history (starting from late
adolescence/early adulthood) of experiencing worsening
2. Case presentation mood, agitation, irritability, affective lability, and mild
A 40-year-old female with a history of one previous paranoia in the two weeks before menstruation that were of
involuntary inpatient hospitalization for psychotic stark contrast to her normal behavior. These times were often
symptoms was admitted to the inpatient psychiatric unit. marked with interpersonal difficulties due to symptoms,
The patient presented to the emergency department with and always alleviated after menses. She would often feel

Volume 3 Issue 2 (2025) 94 doi: 10.36922/jcbp.4721