Menstrual cycle-dependent variations in mood, rumination, and cortisol: a comparison between women with and without Premenstrual Dysphoric Disorder

经前焦虑障碍（PMDD，DSM-5）的特征是在月经周期的经前阶段的情绪，身体和行为的变化，与临床上显著的痛苦和/或心理社会功能的明显损害。该疾病的潜在病理机制迄今尚未得到充分阐明;除其他因素外，正在讨论内分泌应激轴的病理失调。在第一个资助阶段，我们比较了自发过程中的主观和生理过程在日常生活中的妇女与无PMDD在月经周期的背景下的一个动态评估（AA）的研究。到目前为止，我们的研究结果表明，受影响女性的主观体验、情感和认知过程的相互作用以及主观和内分泌应激反应性都发生了显著的周期相关改变。 在第二个资助阶段，我们希望评估a）在日常生活中诱导自我集中注意力焦点（反刍，正念）的群体和周期依赖性影响，在新招募的样本中，有（n=65）和没有（n=65）PMDD的女性。为此，AA测量将在一个月经周期（卵泡期、黄体晚期）的2*4天进行，每个周期阶段4天中有2天进行相应的诱导。我们预期这两种诱导方式在日常生活中对情绪、认知和皮质醇分泌有不同的影响，尤其是对黄体晚期经前抑郁症患者。B）在测量突发设计的背景下，我们将在4个月随访时对PMDD女性患者重复2*4天AA期。除了通过日常生活中评估的这些AA变量预测PMDD的临床病程外，（情绪、认知、对不同诱导方式的反应性、主观和生理应激反应性的水平和变化）这将允许纵向研究这些所谓的AA表型本身以及它们在不同时间尺度上可能的周期依赖性和决定因素（瞬时水平、突发水平、人员水平）。目前的AA研究与预期的测量突发设计一起，将为月经周期研究提供一种新的方法。本研究的结果将为PMDD的潜在压力相关的主观和内分泌机制提供重要证据，促进对PMDD影响的妇女的预防和治疗干预措施的进一步调查。

Premenstrual Dysphoric Disorder (PMDD, DSM-5) is characterized by emotional, physical and behavioral changes during the premenstrual phase of the menstrual cycle, associated with clinically significant distress and/or marked impairment of psychosocial functioning. The disorder’s potential pathomechanisms have so far been insufficiently clarified; amongst other factors a pathological dysregulation of the endocrinological stress axis is being discussed. In the first funding phase we compared the spontaneous course of subjective and physiological processes during daily life in women with and without PMDD over the menstrual cycle within the context of an Ambulatory Assessment (AA) study. Our results achieved so far point to significant cycle-related alterations in subjective experiences, the interplay of affective and cognitive processes, and with regard to subjective and endocrinological stress reactivity in affected women. In the second funding phase we want to assess a) group- and cycle-dependent effects of induced self-focused attention foci (rumination, mindfulness) during daily life in a newly recruited sample of women with (n=65) and without (n=65) PMDD. For this purpose, AA measurements will take place at 2*4 days during one menstrual cycle (follicular phase, late luteal phase) with respective inductions on 2 out of 4 days per cycle phase each. We expect differential effects of the two induction modalities on mood, cognitions, and cortisol secretion during daily life, especially on women with PMDD during the late luteal phase. B) within the context of a measurement burst design we will repeat the 2*4 day AA period at a 4-month FU in women with PMDD. Besides the prediction of the clinical course of the PMDD symptomatology by means of these AA variables assessed during daily life (level and variability of mood, cognition, reactivity to differential induction modalities, subjective and physiological stress reactivity) this will allow to investigate these so-called AA-phenotypes per se longitudinally together with their possible cycle-dependence and determinants on different time scales (momentary level, burst level, person level). The present AA-study together with the intended measurement burst design will render a new approach to menstrual cycle research. The results of the study will provide important evidence on potential stress-related subjective and endocrinological mechanisms in PMDD, facilitating the further investigation of preventive and therapeutic interventions for women affected by PMDD.