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CHAPTER 10 - IMAGES OF PMS
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Is It Real? You Bet!
Chris
Chris was a thirty-eight-year-old married female referred for evaluation of suicidal
thoughts, depression and temper flares. She also experienced problems with anxiety,
excessive tension and overeating. These problems occurred primarily during the last 10
days of her menstrual cycle and abated two to three days after the onset of menses. On
three separate occassions she left her husband within the 10 days prior to the onset of
her period, on one occasion, she attacked him physically. The patient and her husband
confirmed the cyclic changes to her symptomatology. Both the patient and her husband kept
a symptom log over the next month and she gave consent to participate in the study.
On day 27 (of a 29 day cycle) Chris called the clinic, saying that she was having problems
with suicidal thoughts and depression. She was scanned the same day. Her SPECT study
revealed significant increased activity in the anterior cingulate gyrus and marked
decreased activity in the left temporal lobe and prefrontal cortex bilaterally. She was
then scanned on day 8 of the next menstrual cycle when she was symptom free. Her follow-up
scan revealed improved temporal lobe and prefrontal cortex function but persistent
cingulate hyperactivity.
Due to the clear temporal lobe pathology Chris was placed on divalproate which stabilized
her temper outbursts and suicidal thoughts. Sertraline was then added a month later due to
persistent premenstrual sadness. Twenty-four cycles later she remains symptom free.
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