Page 102 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Menstrual psychosis and treatment

Table 1. Classification by timing within menstrual cycle 1 conclusion regarding hormone levels, symptoms, and
treatment response cannot be made for this patient,
Classification Description inferences can be made given the time course of symptoms
Premenstrual Starts during the second half of the cycle, and and response to contraceptive medication. Further research
psychosis sometimes end with abrupt recovery at the
onset of menstrual bleeding is needed to determine the role of menstrual cycles in
Catamenial psychosis Begins with the onset of menstrual flow mental health disorders and to identify effective treatment
options for these conditions. Documenting pre- and
Para-menstrual Psychoses with variable timing, always in post-treatment hormonal levels may provide valuable
psychosis harmony with the menstrual cycle
Mid-cycle psychosis The onset is mid-way of menstrual bleeding information into the etiology of menstrual psychosis as
well as treatment response.
Epochal menstrual Bipolar psychoses lasting for the complete
psychosis cycle, with switches linked to menstruation
4. Conclusion
Menstrual psychosis is a rare and self-limiting illness
controversy, these researchers agree that antipsychotic characterized by the acute onset of psychotic symptoms
treatment is usually ineffective and that steroid hormones
and clomiphene are better treatment options. While case during certain stages of the menstrual cycle. The
reports alone cannot guide treatment or policy, they offer relationship between psychosis and the menstrual cycle
is not easy for clinicians to recognize, especially at the
valuable learning resources for science and suggest areas
for future research. 11 first presentation. This case report describes a 40-year-
old female who presented to the inpatient psychiatric
Treatment for psychosis related to menstruation unit with psychotic symptoms including delusions,
typically involves antipsychotics, but some evidence paranoia, disorganized thought process, and agitation
suggests combining antipsychotics with contraceptives coinciding with the premenstrual phase of her period.
3
may be effective for treatment and prevention. In a case She was stabilized on a regimen of olanzapine and a
series by Ray and Paul, a 14-year-old girl with a diagnosis medroxyprogesterone hormonal contraceptive injection.
12
of possible menstrual psychosis was initially treated with The patient also had a history of sexual abuse that may
olanzapine (continued at 10 mg/day) and then prescribed have impacted her symptoms. Medical records showed no
oral contraceptive pills containing norethindrone/ethinyl recrudescence of psychotic symptoms and no subsequent
estradiol. She was eventually tapered off olanzapine and psychiatric hospitalizations throughout the follow-up
remained stable on only the oral contraceptive. Our case period. Research on menstrual-related psychosis remains
supports the use of contraceptives in patients experiencing limited, and this case adds valuable data to the developing
menstrual psychosis. body of knowledge in this area.
This case highlights the importance of considering
menstrual cycles in mental health disorders. The patient Acknowledgments
reported a worsening of symptoms in the week before her None.
period, which aligns with a possible menstrual-related
component. The patient’s symptoms were consistent with Funding
unspecified psychosis and raised suspicion for substance- None.
induced psychosis, mood disorder with psychotic features,
and organic psychotic disorder. Her use of cannabinoids Conflict of interest
and methylphenidate may have contributed to worsening
symptoms, possibly explaining why this was the first The authors declare no competing of interest.
hospitalization. Olanzapine does not appear to have
prevented relapse of psychotic symptoms during the next Author contributions
period, consistent with other case reports indicating that Conceptualization: John C. Garman
olanzapine does not completely resolve cases of menstrual Investigation: All authors
psychosis. 13,14 However, her continued improvement Writing–original draft: John C. Garman
with olanzapine and contraceptive use may suggest an Writing–review & editing: All authors
effective treatment combination for patients suffering from
menstruation-related psychosis. Ethics approval and consent to participate
A limitation of this study is that we did not have Patient gave written consent before her participation after
pre- and post-treatment hormone levels. While a definitive her psychotic condition improved.

Volume 3 Issue 2 (2025) 96 doi: 10.36922/jcbp.4721