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CHAPTER 10 - IMAGES OF PMS
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Is It Real? You Bet!
Danielle
Danielle was a thirty-three-year-old married female referred for evaluation of suicidal
thoughts, depression, anxiety and irritability. These problems occurred predominantly
during the last week her menstrual cycle and significantly let up several days after the
onset of menses. She had experience a post-partum depression after the birth of one child
but not after the birth of her other 2 children. 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 25 (of a 28 day cycle) Danielle called the clinic, complaining of severe agitation
and moodiness. She was scanned the same day. Her SPECT study revealed significant
increased activity in the anterior and central cingulate gyrus and increased activity in
the left basal ganglia and deep left temporal lobe. Also, there was decreased activity in
the prefrontal cortex and left temporal lobe. She was then scanned on day 10 of the next
menstrual cycle when she was symptom free. Her follow-up scan revealed improved a calming
of the cingulate, basal ganglia and temporal lobe hyperactivity and improved activity in
the prefrontal cortex and temporal lobes.
Divalproate, sertraline and fluoxetine were ineffective in treating her symptoms, but she
had a positive response to lithium carbonate at a dose of 1,200 milligrams a day, with a
blood level of 0.6 mcg/dl. Three years later she remains symptom free during the
premenstrual period.
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