Core symptoms and profiles in premenstrual syndrome

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DESCRIPTION (provided by applicant): This is a competing continuation of our studies of premenstrual syndromes (PMS). PMS is a complex and chronic disorder that involves mood, behavioral and physical symptoms that are linked to women's menstrual cycles and disrupt functioning for several days to 2 weeks each month. The specific aims of this application are to utilize existing data from women who sought treatment for PMS in our NIH studies to determine the following: 1) Identify a subset of 5-7 core symptoms of clinically significant PMS and their associations with functional impairment; 2) Identify symptom profiles (clusters) in women with severe PMS. 3) Test whether the profiles differentially respond to serotonergic antidepressant treatment; compare the improvement associated with symptom profiles with improvement associated with core symptoms to determine whether symptom profiles are more clinically meaningful than core symptoms identified in Aim 1. 4) Compare PMS symptoms and symptom profiles between African American and Caucasian women. Although approximately 20% of menstruating women suffer from PMS to a degree that is severely distressing and disrupts daily functioning, there are no demonstrated and widely accepted criteria for a diagnosis of PMS. While the utility of premenstrual dysphoric disorder (PMDD) is demonstrated for research purposes, its restrictive criteria fail to include the majority of cases in the clinical setting. The absence of a widely-accepted diagnosis for PMS has significant economic costs that result from poor diagnosis and inadequate treatment as evidenced in the increased costs of health care services for these women. There are also high personal costs as indicated by the burden of disease over their reproductive lifetimes. Identifying core symptoms of PMS and the symptoms that significantly contribute to the impairment of PMS can contribute to a more evidence-based and widely-accepted diagnosis of this disorder. Identifying symptoms and/or symptom profiles that respond to SSRI treatment can improve the use of this treatment for symptoms that are more likely to respond. Whether there are racial differences in PMS symptoms is not known but is important for health care. Information from this study can also reduce the heterogeneity of symptoms in women selected for research studies, resulting in more consistent findings across studies and increasing the potential for identifying underlying mechanisms of the disorder. Results of the study are particularly important for primary care where evaluations of a plethora of symptoms are seldom conducted or feasible, and there is no systematic approach to identifying cases. Further information will contribute to improved health care for women in their reproductive years.