Premenstrual dysphoric disorder (PMDD): The Daily PANCE Blueprint
A 28-year-old woman comes to your clinic complaining of severe mood swings, irritability, and feelings of hopelessness that occur primarily in the week before her menstrual period and resolve within a few days of the onset of menses. She says these symptoms have been recurring for the past 6 months and are affecting her work and relationships. She denies any history of psychiatric illness. Which of the following is the most appropriate diagnostic step to confirm a diagnosis of premenstrual dysphoric disorder (PMDD)?
A. Serum hormone levels
B. Daily symptom diary for two menstrual cycles
C. Beck Depression Inventory
D. MRI of the brain
E. Thyroid function tests
Answer and topic summary
The answer is B. Daily symptom diary for two menstrual cycles
The diagnosis of PMDD is primarily clinical and based on the patient’s symptomatology. The American College of Obstetricians and Gynecologists (ACOG) recommends keeping a daily symptom diary for at least two menstrual cycles to confirm the diagnosis. The diary helps to establish the temporal relationship between symptoms and the menstrual cycle, which is crucial for diagnosing PMDD.
Incorrect Answer Explanations:
- A. Serum hormone levels: Hormone levels are generally not useful for diagnosing PMDD as they are often within the normal range.
- C. Beck Depression Inventory: While this tool is useful for diagnosing depression, it does not capture the cyclical nature of PMDD symptoms.
- D. MRI of the brain: Imaging studies are not indicated for PMDD unless other neurological symptoms suggest a different diagnosis.
- E. Thyroid function tests: While thyroid dysfunction can cause mood disturbances, it would not explain the cyclical nature of the symptoms related to the menstrual cycle.
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