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  • 1. Hanlon, Charlotte
    et al.
    Whitley, Rob
    Wondimagegn, Dawit
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Prince, Martin
    Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia2010Ingår i: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 13, nr 5, s. 385-393Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The high prevalence of antenatal common mental disorders in sub-Saharan Africa compared to high-income countries is poorly understood. This qualitative study explored the sociocultural context of antenatal mental distress in a rural Ethiopian community. Five focus group discussions and 25 in-depth interviews were conducted with purposively sampled community stakeholders. Inductive analysis was used to develop final themes. Worry about forthcoming delivery and fears for the woman's survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity. Sociocultural practices such as continuing physical labour, dietary restriction, prayer and rituals to protect against supernatural attack were geared towards safe delivery and managing vulnerability. Despite strong cultural norms to celebrate pregnancy, participants emphasised that many pregnancies were unwanted and an additional burden on top of pre-existing economic and marital difficulties. Short birth interval and pregnancy out of wedlock were both seen as shameful and potent sources of mental distress. The notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced. Although antenatal mental distress may be self-limiting for many women, in those with enduring life difficulties, including poverty and abusive relationships, poor maternal mental health may persist.

  • 2. Ismail, Khaled M. K.
    et al.
    Nevatte, Tracy
    O'Brien, Shaughn
    Paschetta, Elena
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Dennerstein, Lorraine
    Eriksson, Elias
    Freeman, Ellen W.
    Panay, Nick
    Pearlstein, Teri
    Rapkin, Andrea
    Steiner, Meir
    Studd, John
    Sundstrom-Poromaa, Inger
    Clinical subtypes of core premenstrual disorders: a Delphi survey2013Ingår i: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 16, nr 3, s. 197-201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to classify the clinical subtypes of core premenstrual disorders during the International Society for Premenstrual Disorders' second consensus meeting. Multiple iterations were used to achieve consensus between a group of experts; these iterations included a two-generational Delphi technique that was preceded and followed by open group discussions. The first round was to generate a list of all potential clinical subtypes, which were subsequently prioritized using a Delphi methodology and then finalised in a final round of open discussion. On a six-point scale, 4 of the 12 potential clinical subtypes had a mean score of a parts per thousand yen5.0 following the second iteration and only 3 of the 4 still had a mean score of a parts per thousand yen5.0 after the third iteration. The final list consisted of these three subtypes and an additional subtype, which was introduced and agreed upon, in the final iteration. There is consensus amongst experts that core premenstrual disorder is divided into three symptom-based subtypes: predominantly physical, predominantly psychological and mixed. A proportion of psychological and mixed subtypes may meet the DSM-IV diagnostic criteria for premenstrual dysphoric disorder.

  • 3. Nevatte, Tracy
    et al.
    O'Brien, Patrick Michael Shaughn
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Brown, Candace
    Dennerstein, Lorraine
    Endicott, Jean
    Epperson, C. Neill
    Eriksson, Elias
    Freeman, Ellen W.
    Halbreich, Uriel
    Ismail, Khalid
    Panay, Nicholas
    Pearlstein, Teri
    Rapkin, Andrea
    Reid, Robert
    Rubinow, David
    Schmidt, Peter
    Steiner, Meir
    Studd, John
    Sundstrom-Poromaa, Inger
    Yonkers, Kimberly
    ISPMD consensus on the management of premenstrual disorders2013Ingår i: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 16, nr 4, s. 279-291Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The second consensus meeting of the International Society for Premenstrual Disorders (ISPMD) took place in London during March 2011. The primary goal was to evaluate the published evidence and consider the expert opinions of the ISPMD members to reach a consensus on advice for the management of premenstrual disorders. Gynaecologists, psychiatrists, psychologists and pharmacologists each formally presented the evidence within their area of expertise; this was followed by an in-depth discussion leading to consensus recommendations. This article provides a comprehensive review of the outcomes from the meeting. The group discussed and agreed that careful diagnosis based on the recommendations and classification derived from the first ISPMD consensus conference is essential and should underlie the appropriate management strategy. Options for the management of premenstrual disorders fall under two broad categories, (a) those influencing central nervous activity, particularly the modulation of the neurotransmitter serotonin and (b) those that suppress ovulation. Psychotropic medication, such as selective serotonin reuptake inhibitors, probably acts by dampening the influence of sex steroids on the brain. Oral contraceptives, gonadotropin-releasing hormone agonists, danazol and estradiol all most likely function by ovulation suppression. The role of oophorectomy was also considered in this respect. Alternative therapies are also addressed, with, e.g. cognitive behavioural therapy, calcium supplements and Vitex agnus castus warranting further exploration.

  • 4. O'Brien, Patrick Michael Shaughn
    et al.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap.
    Brown, Candace
    Dennerstein, Lorraine
    Endicott, Jean
    Epperson, C Neill
    Eriksson, Elias
    Freeman, Ellen
    Halbreich, Uriel
    Ismail, Khaled M K
    Panay, Nicholas
    Pearlstein, Teri
    Rapkin, Andrea
    Reid, Robert
    Schmidt, Peter
    Steiner, Meir
    Studd, John
    Yonkers, Kimberley
    Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus2011Ingår i: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 14, nr 1, s. 13-21Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Premenstrual disorders (PMD) are characterised by a cluster of somatic and psychological symptoms of varying severity that occur during the luteal phase of the menstrual cycle and resolve during menses (Freeman and Sondheimer, Prim Care Companion J Clin Psychiatry 5:30-39, 2003; Halbreich, Gynecol Endocrinol 19:320-334, 2004). Although PMD have been widely recognised for many decades, their precise cause is still unknown and there are no definitive, universally accepted diagnostic criteria. To consider this issue, an international multidisciplinary group of experts met at a face-to-face consensus meeting to review current definitions and diagnostic criteria for PMD. This was followed by extensive correspondence. The consensus group formally became established as the International Society for Premenstrual Disorders (ISPMD). The inaugural meeting of the ISPMD was held in Montreal in September 2008. The primary aim was to provide a unified approach for the diagnostic criteria of PMD, their quantification and guidelines on clinical trial design. This report summarises their recommendations. It is hoped that the criteria proposed here will inform discussions of the next edition of the World Health Organisation's International Classification of Diseases (ICD-11), and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) criteria that are currently under consideration. It is also hoped that the proposed definitions and guidelines could be used by all clinicians and investigators to provide a consistent approach to the diagnosis and treatment of PMD and to aid scientific and clinical research in this field.

  • 5. Segebladh, Birgitta
    et al.
    Bannbers, Elin
    Moby, Lena
    Nyberg, Sigrid
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Poromaa, Inger Sundstrom
    Allopregnanolone serum concentrations and diurnal cortisol secretion in women with premenstrual dysphoric disorder2013Ingår i: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 16, nr 2, s. 131-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Most prior studies in patients with premenstrual dysphoric disorder (PMDD) indicate a blunted hypothalamus-pituitary-adrenal axis function. However, the relationship between neuroactive progesterone metabolites, such as allopregnanolone, and hypothalamus-pituitary-adrenal (HPA) axis function in PMDD patients is relatively sparsely studied. The primary aims of this study were to assess diurnal variation in circulating cortisol and low-dose dexamethasone suppression in PMDD patients and healthy controls, and the relationship between these two HPA axis indices and allopregnanolone serum concentrations. Twenty-six women with prospectively defined PMDD and 30 healthy controls were recruited. Participants underwent diurnal sampling for cortisol serum concentrations and a low-dose dexamethasone suppression test. In addition, morning allopregnanolone serum concentrations were determined. There was no difference in diurnal secretion of cortisol and degree of dexamethasone suppression of cortisol between PMDD patients and healthy controls. However, PMDD patients with high allopregnanolone levels displayed blunted nocturnal cortisol levels in comparison with healthy controls who had low allopregnanolone serum concentrations. In women with PMDD, diurnal secretion of cortisol may be influenced by allopregnanolone levels of the luteal phase. This finding may be attributed to timing of blood sampling in the late luteal phase as well as the individual level of allopregnanolone but could potentially explain the discrepancies in results between studies examining HPA axis function in women with PMDD.

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