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Acta Psychiatr Scand. 2017 Nov;136(5):473-482. doi: 10.1111/acps.12797. Epub 2017 Aug 28.

Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study.

Author information

1
MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.
2
Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada.
3
Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
4
Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, Brazil.
5
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
6
Massachusetts General Hospital, Boston, MA, USA.

Abstract

BACKGROUND:

The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown.

AIMS:

We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD.

MATERIALS & METHODS:

A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria.

RESULTS:

Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001).

DISCUSSION:

The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD.

CONCLUSIONS:

The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00012558.

KEYWORDS:

age of onset; bipolar disorder; burden of illness; menarche; premenstrual dysphoric disorder

PMID:
28846801
PMCID:
PMC5630503
DOI:
10.1111/acps.12797
[Indexed for MEDLINE]
Free PMC Article

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