Diana Carter

The measurement of premenstrual mood symptoms

INTRODUCTION To aid in the diagnosis and management of premenstrual syndromes, dozens of symptom measurement instruments have been created and several methods for classifying clinically important change in symptoms have been defined. While the diagnosis of premenstrual dysphoric disorder (PMDD) has become standardized through the application of research criteria, consensus amongst investigators as to the instruments best able to confirm the diagnosis and measure treatment effects has yet to be reached. OBJECTIVE To determine the performance and inter-correlations of three prospective symptom rating scales used to establish severity of premenstrual mood symptoms and measure efficacy during a treatment trial for premenstrual dysphoria. METHODS Single item visual analogue scales (VASs) for irritability, tension, depression and mood swings were used in combination with the Premenstrual Tension Syndrome Observer (PMTS-O) and Self-Rating (PMTS-SR) scales to measure the severity of premenstrual mood symptoms at baseline and during treatment. RESULTS Premenstrual mood symptoms as measured by VASs significantly correlated with PMTS-0 and PMTS-SR scale scores (range 0.70 to 0.82, P < 0.001). All scales were sensitive to premenstrual symptom worsening (which is a required characteristic of this disorder) and revealed differences in effects of treatment on premenstrual mood symptoms (P < 0.001). CONCLUSIONS VASs in combination with the PMTS-O are low in burden to the client, reliable, valid and sensitive to change. In light of the current debates regarding instruments most appropriate for the classification and measurement of treatment effects in women diagnosed with premenstrual dysphoria, further refinement of these scales is warranted.

A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu

OBJECTIVES To measure the prevalence of depression amongst postpartum and non‐postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria for major depression.

A controlled study of light therapy in women with late luteal phase dysphoric disorder

Previous studies suggest that light therapy, as used to treat seasonal affective disorder, may be beneficial for pre-menstrual depressive disorders. We conducted a six-menstrual cycle randomized, double-blind, counter-balanced, crossover study of dim vs. bright light therapy in women with late luteal phase dysphoric disorder (LLPDD). Fourteen women who met DSM-III-R criteria for LLPDD completed two menstrual cycles of prospective baseline monitoring of pre-menstrual symptoms, followed by two cycles of each treatment. During the 2-week luteal phase of each treatment cycle, patients were randomized to receive 30 min of evening light therapy using: (1) 10000 lx cool-white fluorescent light (active condition); or (2) 500 lx red fluorescent light (placebo condition), administered by a light box at their homes. After two menstrual cycles of treatment, patients were immediately crossed over to the other condition for another two cycles. Outcome measures were assessed at the mid-follicular and luteal phases of each cycle. Results showed that the active bright white light condition significantly reduced depression and pre-menstrual tension scores during the symptomatic luteal phase, compared to baseline, while the placebo dim red light condition did not. These results suggest that bright light therapy is an effective treatment for LLPDD.

Relation Between Prenatal Maternal Mood and Anxiety and Neonatal Health

Objective: To examine the relation between the mood and anxiety of pregnant, psychiatrically treated women and neonatal health outcomes after birth. Method: We prospectively assessed 46 women treated with psychotropic medications for anxiety and depression during pregnancy. We compared measures of maternal mental health with infant outcomes, in particular, the outcomes of infants with symptoms of poor neonatal adaptation. Results: The mothers of babies who demonstrated poor neonatal adaptation reported higher levels of anxiety and depression at study entry than did the mothers of healthy babies. This relation was not related to the presence or absence of treatment with clonazepam, an anxiolytic used to treat symptoms of anxiety. Further, increased psychiatric comorbidity in the mother was associated with a greater likelihood of transient symptoms in the newborn. Conclusions: Despite psychiatric treatment, the intensity and degree of comorbid symptoms appear to be related to poor transient neonatal health outcome. Our data suggest that, in addition to the impact of pharmacologic factors, maternal psychiatric status influences infant outcomes.

The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder

Objective To determine the effectiveness of fluoxetine in alleviating physical symptoms of premenstrual dysphoric disorder.

Psychologic aspects of early pregnancy loss.

Early pregnancy loss is a complicated psychologic event that occurs in 12% to 24% of recognized pregnancies. Women who have experienced miscarriage often have common bereavement reactions and while the intensity and experience of these reactions diminishes over time for most women, a substantial minority will develop long-term psychiatric consequences. Depression, symptoms of anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder are the most commonly reported psychologic reactions to miscarriage. The course and impact of these disorders on a grieving mother and her partner are discussed and treatment recommendations are made. The psychologic effects of therapeutic abortion are also be briefly discussed.

A systematic comparison of factors affecting the choice of matrix language in three bilingual communities

In this paper we compare the code-switching (CS) patterns in three bilingual corpora collected in Wales, Miami and Patagonia, Argentina. Using the Matrix Language Framework to do a clause-based analysis of a sample of data, we consider the impact of structural relationships and extra-linguistic factors on CS patterns. We find that the Matrix Language (ML) is uniform where the language pairs have contrasting word orders, as in Welsh-English (VSO-SVO) and WelshSpanish (VSO-SVO) but diverse where the word order is similar as in Spanish-English (SVO-SVO). We find that the diversity of the ML in Miami is related to the diversity of degrees of proficiency, ethnic identities, and social networks amongst members of that community, while the uniformity of the ML in Wales is related to the uniformity of these factors. This is not so clear in Patagonia, however, where there is little CS produced in conversation. We suggest that the members of the speech community use Spanish or Welsh mostly in a monolingual mode, depending on the interlocutor and the social situation.

Premenstrual complaints before and after 40 years of age.

factors in the severity of affective illness. Biol Psychiatry 1976;11:31–42. 13. Dunner DL, Tay KL. Diagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression. Compr Psychiatry 1993;34:303–7. 14. Akiskal HS, Hantouche EG, Allilaire JF. Bipolar II with and without cyclothymic temperament: “dark” and “sunny” expressions of soft bipolarity. J Affect Disord 2003;73:49–57. 15. Ghaemi SN, Ko JY, Goodwin FK. “Cade’s disease” and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can J Psychiatry 2002;47:125–34.

Presenting the Bangor Autoglosser and the Bangor Automated Clause-Splitter

Until recently, corpus studies of natural bilingual speech and, more specifically, codeswitching in bilingual speech have used a manual method of glossing, partof-speech tagging, and clause-splitting to prepare the data for analysis. In our article, we present innovative tools developed for the first large-scale corpus study of codeswitching triggered by cognates. A study of this size was only possible due to the automation of several steps, such as morpheme-by-morpheme glossing, splitting complex clauses into simple clauses, and the analysis of internal and external codeswitching through the use of database tables, algorithms, and a scripting language. .................................................................................................................................................................................

Assessment of sexual drive and desire in women with premenstrual dysphoric disorder who have been treated with fluoxetine

Objective To explore the impact of treatment with fluoxetine on sexual drive and desire (SDD) in women with premenstrual dysphoric disorder (PMDD). Methods Data were collected during a randomised, controlled, double-blind trial evaluating the efficacy of fluoxetine 20 or 60 mg/day versus placebo in the treatment of women with PMDD. Study subjects rated their SDD on the Premenstrual Tension Scale, Self Rating (PMTS-SR) during their follicular and luteal phases of the placebo run in cycles and the double-blind treatment cycles. Data were analyzed using chi-square test. Results Data were available for 184 subjects who rated their SDD during the follicular and luteal phases of two baseline (placebo) cycles and the following two treatment cycles. There was a trend for more women on fluoxetine to report improvement in luteal phase SDD compared to women on placebo (P=0.057). Conclusions Our data, contrary to expectations, suggest that fluoxetine treatment may restore SDD in women who experience decreased SDD as part of a cluster of symptoms associated with PMDD. Future trials with SSRIs should include specific measures of sexual functioning to further examine the potential beneficial versus side effects of these medications as they relate to phases of the menstrual cycle.