Psychoneuroendocrinology

For the scientific journal, see Psychoneuroendocrinology (journal).

Psychoneuroendocrinology is the clinical study of hormone fluctuations and their relationship to human behavior. It may be viewed from the perspective of psychiatry, where in certain mood disorders, there are associated neuroendocrine or hormonal changes affecting the brain. It may also be viewed from the perspective of endocrinology, where certain endocrine disorders can be associated with negative health outcomes and psychiatric illness. Brain dysfunctions associated with the hypothalamus-pituitary- adrenal axis HPA axis can affect the endocrine system, which in turn can result in physiological and psychological symptoms. This complex blend of psychiatry, psychology, neurology, biochemistry, and endocrinology is needed to comprehensively understand and treat symptoms related to the brain, endocrine system (hormones), and psychological health. (see neurobiological brain disorder).

Disorders

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder

Premenstrual syndrome is a mood disorder which occurs recurrently in the late luteal phase of the menstrual cycle and remits within the first day or two after the onset of menstruation.<ref name="APP textbook">Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psychiatric Publishing, Inc., 2003</ref> Symptoms include depression, irritability, anxiety, insomnia, bloating, breast tenderness, cramping, and headaches.<ref name="APP textbook"/> About 5-9% of women of child-bearing age meet the DSM-IV criteria for PMDD.<ref name="APP textbook"/> In some women, end-of-cycle worsening actually represents "menstrual magnification" of an underlying mood disorder.<ref name ="Stahl">Stahl SM, Stahl's Essential Psychopharmacology: Neuroscientific basis and practical applications, New York: Cambridge University Press, 2008</ref>

Premenstrual dysphoric disorder can be treated cyclically with hormonal oral contraceptives, or with antidepressants, which may be used continuously or only during the late luteal phase.<ref name="Stahl"/> Selective serotonin reuptake inhibitors, or SSRIs, have been found to be effective in the treatment of PMDD.<ref name="APP textbook"/> Physical symptoms can be affected by the intake of caffeine, salt, alcohol, and nicotine, so the use of these substances should be monitored and potentially decreased.<ref name="APP textbook"/> Sleep hygiene measures, exercise, relaxation therapy, and cognitive behavioral therapy are all potentially effective non-medication strategies for milder symptoms.<ref name="APP textbook"/>

Postpartum Depression (PPD)

Postpartum psychiatric disorders typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness.

Up to 85% of women experience postpartum blues during the first two weeks after delivery.<ref name="O'Hara">O'Hara MW ed, Postpartum Depression: Causes and Consequences, New York: Springer-Verlag, 1995</ref> Symptoms include tearfulness, mood lability, irritability, and anxiety. These symptoms typically peak between postpartum days 5-7, and remit spontaneously within two weeks postpartum, so active treatment is not required.<ref name="APP textbook"/>

Postpartum depression refers to a major depressive episode occurring following childbirth. While women can become depressed at different points in time following childbirth, the "postpartum-onset" specifier in the DSM-IV-TR is applied for depression with onset in the first four weeks post-partum.<ref name=DSM-IV>,

 Diagnostic and statistical manual of mental disorders (4th ed., text revision), 
  
 Washington DC:American Psychiatric Association, 
 2000, 
  
  
 ISBN 978-0890420256,</ref>  The risk of postpartum depression is increased by depression during pregnancy, or a history of postpartum depression.<ref name="O'Hara"/>  The Edinburgh Postnatal Depression Scale<ref>Edinburgh Postnatal Depression Scale Archived 2007-09-26 at the Wayback Machine</ref> is a 10-item questionnaire that may be used to identify women who have PPD. On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raise concern and indicate a need for more thorough evaluation.

Treatment of postpartum depression can include individual or group psychotherapy, medication, and supportive interventions.<ref name="APP textbook"/> A combination of individual psychotherapy (particularly cognitive therapy) and medication has been shown to be effective.<ref name="APP textbook"/> There are no standard guidelines regarding medication therapy. The potential risk of infant exposure to small amounts of antidepressants in breast milk is unclear, so in each individual woman the risk of not taking antidepressants must be balanced against the risk of either not breastfeeding or potentially exposing the infant with continued breastfeeding.<ref name="Stahl"/> There is some reassuring data on the safety of SSRI antidepressants, and infants nursed by mothers taking SSRIS typically receive low levels of medication exposure.<ref>,

 The Use of Psychotropic Medications During Breast-Feeding, 
 American Journal of Psychiatry, 
 2001,
 Vol. 158,
 pp. 1001–1009,
 DOI: 10.1176/appi.ajp.158.7.1001,</ref>

Postpartum Psychosis

Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth.<ref name="O'Hara"/> Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks. <ref>Postpartum Psychiatric Disorders Archived 2006-10-10 at the Wayback Machine</ref>

Symptoms include mood lability, agitation, confusion, thought disorganization, hallucinations, and disturbed sleep. The risk of developing postpartum psychosis is increased by a history of bipolar disorder, previous episodes of postpartum psychosis, a family history of bipolar disorder, and the current pregnancy being a woman's first.<ref name="APP textbook"/><ref name="O'Hara"/> Consequences of postpartum psychosis can be significant, including suicide, infant neglect, and infanticide,<ref>,

 Postpartum Psychoses: Onset and Long-Term Course, 
 Psychopathology, 
 1993,
 Vol. 26,
 pp. 203–209,
 DOI: 10.1159/000284823,</ref> so women with this condition are generally hospitalized.<ref name="APP textbook"/>  Acute treatment includes the use of a mood stabilizer, and antipsychotic, and if necessary a benzodiazepine for agitation.<ref name="APP textbook"/>

External links

• MGH Center for Women's Mental Health
• Psychiatric Disorders During Pregnancy
• Postpartum Psychiatric Disorders
• Breastfeeding and Psychiatric Medication
• Endocrinology and Psychiatry
• ,

 Psychoneuroendocrine effects of resource-activating stress management training, 
 Health Psychol, 
 
 Vol. 26(Issue: 4),
 pp. 456–63,
 DOI: 10.1037/0278-6133.26.4.456,
 PMID: 17605565,

References

www.neuroendocrinology.org