Dergi Ara >>
Yıl:2011; Cilt: 14; Sayı: 4>> Özet
TAM METİN
Klinik Psikiyatri Dergisi; 2011;14(4):241-253
Premenstruel Sendrom ve Premenstruel Disforik Bozuklukta Tanı ve Tedavi: Bir Gözden Geçirme
AF Türkçapar, H Türkçapar
Zekai Tahir Burak Kadın Hastalıkları ve Doğum Eğitim ve Araştırma Hastanesi, Ankara
Premenstruel sendrom kadınlarda menstruel döngünün geç luteal döneminde memelerde şişkinlik, başağrısı, halsizlik ve kilo alımı gibi fiziksel ve depresif duygudurum, irritabilite, gerginlik gibi ruhsal belirtilerle kendini ortaya koyan bir tablodur. Bu tablo genellikle mensturasyonun başlamasıyla ortadan kalkar. Bu sendrom kadın popülasyonun % 80'inde görülmekle beraber yaklaşık %5 kadında klinik olarak anlamlı olacak şekilde şiddetlidir. Bu belirtilerin klinik veya sosyal olarak etkili olacak düzeyde olması durumunda Premensturel Disforik Bozukluk veya Geç Luteal Faz Bozukluğu adıyla bir psikiyatrik rahatsızlık olarak sınıflandırılması önerilmektedir. Bu gözden geçirme yazısında premenstruel sendrom ve premenstruel disforik bozukluğun tanı, etyoloji ve tedavisine ilişkin güncel literatür gözden geçirilmiştir. Rahatsızlığın biyolojik etyolojisi, her kadında görülen gonadal steroi-dlerdeki normal dalgalanmaya karşı bazı kadınların daha hassas olması ve bu hormonal etkilerin kendisini bedensel ve ruhsal belirtilerle ortaya koyması biçimindedir. Psikososyal etkenlerde belirtilerin şiddetini etkilemektedir. Güncel bulgular bu rahatsızlığın hormonal etkenlerle santral sinir sistemi arasındaki etkileşimden kaynaklandığını ve gerek farmakolojik gerekse de psikososyal yöntemlerin bu rahatsızlığın belirtilerini azaltabileceğini göstermektedir. Hafif vakalarda yaşam stili değişikliği yeterli olurken şiddetli vakalarda hormonal tedavi ve serotonin geri alım engelleyicileri kullanılmaktadır. Bu hastalarda ilaç tedavisine alternatif olarak bilişsel davranışçı terapide kullanılabilmektedir.
Diagnosis and Treatment of Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Review
Premenstrual syndrome (PMS) is a condition which
appear at the late luteal phase of menstrual cycles with
physical changes include breast swelling, fatigue,
headache, weight gain and psychological changes
include depressive mood, irritability, and tension. These
changes remit after the onset of menstruation. This syndrome
can occur 80% of women population but it is
severe form can only be seen 5% of women and called
premenstrual dysphoric disorder or late luteal phase syndrome.
In this review, current literature about diagnosis,
etiology and treatment of premenstrual syndrome and
premenstrual dysphoric disorder is examined. We
searched Pubmed Medline (1950-2011)using the terms
“premenstrual syndrome,” “premenstrual dysphoric syndrome,”.
The exact cause of PMS has not been identified,
but several theories were proposed to explain this disorder.
Biological etiology of the disorder explained by the
sensitivity of some women’s to normal biological fluctuations
of gonadal hormones. Psychosocial factors also
influence the severity of symptoms. These biological and
psychological vulnerability presented as somatic and
psychological symptoms of the premenstrual dysphoric
disorder. Current evidences suggested that this disorders
stem from the interaction between hormones and the
central nervous system and pharmacological agents and
psychosocial interventions can alleviate the symptoms of
this disorder. For many women with mild symptoms,
lifestyle approaches are enough to control symptoms. In
severe cases, hormonal treatments and antidepressants
may be helpful. Combined oral contraceptive drugs and
selective serotonin-reuptake inhibitors are used to treat
premenstrual symptoms. Cognitive behavioral therapy
may be an alternative psychosocial treatment to drug
treatments.

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