title: Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review.
abstract: OBJECTIVE
  This article aims to review the comorbidity of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and bipolar disorder (BD), identify variables requiring further investigation and to remind physicians that special care is required for diagnosis and therapy.
  
  
  METHODS
  A systematic review of articles published from 1987 to February 2012 was conducted in the Medline database with the following terms: (premenstrual syndrome OR premenstrual dysphoric disorder OR premenstrual) AND (bipolar OR mania OR manic). Seventeen articles were analyzed.
  
  
  RESULTS
  PMS and PMDD were most often comorbid among BD-II patients and vice versa. Moreover, patients with PMS or PMDD also have an increased risk of having BD-I. In addition, bipolar women susceptible to hormonal changes exhibit more severe symptoms, more frequent relapses and a worse therapeutic response.
  
  
  CONCLUSIONS
  Future investigations should attempt to stabilize hormonal levels through the continuous use of contraceptives to target a reduction in symptom severity. In addition, psychiatrists should note menstrual period dates and compare symptom intensity between the luteal and follicular phases. Finally, PMS and PMDD patients should be studied separately.
authors: Laboratory of Panic & Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. patcirillo@terra.com.br
authors: Patricia Carvalho
authors: PC
authors: Cirillo
authors: Roberta Benitez Freitas
authors: RB
authors: Passos
authors: Mario Cesar do Nascimento
authors: MC
authors: Bevilaqua
authors: Jose Ramón Rodriguez Arras
authors: JR
authors: López
authors: Antônio Egidio
authors: AE
authors: Nardi
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology* / Q000378:metabolism; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D011293:Premenstrual Syndrome / Q000453:epidemiology* / Q000378:metabolism; D011374:Progesterone / Q000378:metabolism; D012959:Socioeconomic Factors
chemical_list: D011374:Progesterone