The Diagnosis and Treatment of Premenstrual Dysphoric Disorder in a Patient Who had been Misdiagnosed as Having Either Rapid Cycling Bipolar I Disorder or Borderline Personality Disorder

抄録

The patient was a 16-year-old high school girl who had been suffering from premenstrual dysphoric disorder (PMDD) expressed as a rapid cycle of manic and depressive episodes. She attempted suicide and spent two months in a psychiatric hospital being treated for depression after which she was tentatively diagnosed as having major depression with borderline personality disorder. Following the first admission, the patient experienced three further manic-depressive episodes before being hospitalized again; all three episodes were related to her menstruation. We directed the patient to keep a daily diary of her psychotic symptoms and to record her basal body temperature. We prescribed the oral contraceptive (Ocps) in a dose of one pill per day for the purpose of interrupting the patient’s menstrual cycle. While experiencing high body temperature the patient tended to be depressed, however, while on a treatment of Ocps her mood stabilized and she was able to lead an otherwise ordinary lifestyle. Patients suffering from PMDD are at risk of being wrongly diagnosed as suffering from borderline personality disorder based on their acting out behavior and instability of mood. We consider that ovulation may play a role in the switch process of this patient’s manic and depressive phases.