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Background
The first mention of menstrual psychosis was in France in 1850. 1 2 Since then, estimates of the total number of cases of menstrual psychosis, of which catamenial psychosis is a specific subtype, are between 80 and 200. 1 Three confirmed cases of catamenial psychosis, with 30 possible cases, have been noted in the literature. 1
There are five different types of menstrual psychosis: premenstrual, catamenial, paramenstrual, mid-cycle and epochal. Classification of menstrual psychosis subtypes is based on the timing of the onset of symptoms during a woman's menstrual cycle. Unlike more common psychotic disorders, menstrual psychosis is characterised by a cyclical presentation of psychotic features with a return to baseline behaviour and function in between episodes. Sex hormone involvement is thought to be key in the explanation of the symptoms. 1-3
While there have been studies suggesting that sex hormones and their changing levels during menstruation can affect pre-existing psychiatric illness and lead to worsening symptoms and increased psychiatric hospitalisations, little is known about the specific role sex hormones play in psychiatric illness. 4 5 Theories as to how the hypothalamic-pituitary-ovarian axis influences symptoms have been brought forth, with the consideration that the level of dysfunction may correlate with the severity of symptoms, but at this time much of what is found is largely theoretical or incomplete. 3 5
In current times, menstrual psychoses and their subtypes are a largely forgotten diagnosis. This case brings into discussion the role of hormonal involvement in women with psychotic illness, especially in those who are partially responsive or treatment-resistant to antipsychotic therapy. With the possibility of hypothalamic-pituitary-ovarian axis involvement in the role of psychosis, this case raises the possibility of hormone therapy as a primary treatment or augmentation in the treatment of females who have persistent psychotic symptoms despite available pharmacotherapy for psychotic illness.
By making healthcare providers aware of this illness, we strive to expand the differential considerations in females who present with psychotic illness. We also highlight the possibility of initiating a broader array of therapeutic strategies that could lead to improved quality of life and possible complete remission of symptoms.
Case presentation
A 14-year-old girl with a history of anxiety and a family history significant for a maternal grandmother and great uncle with...