Wednesday, July 6, 2011

Study links menstruation, menopause and mental illness

MENSTRUATION, menopause and mental illness all have something in common, and it's not just because they all begin with 'men'.

According to one local study, low oestrogen levels during the monthly period or at menopause do contribute to women becoming a little bit more psychotic around these times.

The study entitled Menstrual Cycle and Psychotic Symptom Severity Among Patients of a Psychiatric Treatment Facility in Jamaica, was conducted by consultant psychiatrist Dr Saphire Longmore-Dropinski last year, and is the first such study of its kind in the Caribbean.

Dr Longmore-Dropinski, who was Miss Jamaica Universe 2000, conducted the study as part of her requirement to graduate with a Doctor of Medicine in Psychiatry from the University of the West Indies, Mona. She said she chose to focus on this particular area of research after witnessing a trend among the female patients receiving treatment at the University Hospital of the West Indies where she was working at the time.

"I noticed that on the day, or within two days of them being admitted, they would either have the onset of their menses or were admitted during their menses or their menses were somewhere within a two or three day span, and I just said that I wonder if there was some connection?" she said.

Upon conducting her literary review, she realised that a number of other international studies looking at the connection between hormones and mental illnesses supported her observation. In Australia, for example, schizophrenic men were being given a small dose of oestrogen as part of trial to see how they would react to this type of treatment.

"All over the world there is a layman thing of saying 'don't mess with a woman when she is having her issues', but what I have shown is that there is a definite biological basis to this and it is a very real phenomenon," the doctor pointed out.

While the lowering of oestrogen levels during a woman's period is known to cause a wide range of physical and emotional issues commonly linked to premenstrual syndrome (PMS), Dr Longmore-Dropinski explained that the effects go far beyond the physical and emotional to the psychotic.

"It was significant for illnesses such as schizophrenia and bipolar disorder and more severe mental illnesses. It also plays a role in things like postpartum depression and postpartum psychosis, because after you give birth your oestrogen level drops significantly," she said, while adding that it was also a significant factor in dementia and memory impairment.

Although the psychiatrist needed only 102 female patients for her study, she decided to further enhance the accuracy of her research by assessing the behaviour of 113 in and out-patients during their menstrual period at the psychiatric ward at the hospital. She found that they showed higher psychotic reactions when their oestrogen level was lowest.

"One female severe bipolar patient — let's call her Ann — everytime Ann gets admitted to the hospital, her period has either just started that day or the day after and she literally said 'Doc whenever I know that my period ah come, mi know that mi ago get off," the doctor recounted to All Woman.

She believes her study has significant implications for how medical practitioners go about scheduling their patients' visits and the type of medication they give. She hopes to create awareness among her colleagues that gender plays a significant role in determining the treatment for patients.

"Mental illnesses across the board are very hard to deal with, but we here in the Caribbean tend to treat mental illnesses irrespective of gender. We don't pay attention to whether this is a woman or a man, we usually approach them the same," she said.

She added: "When it comes to women, the fact that we might be able to chart who might be at risk, you can reduce your admitting rates, your burden on the hospitals, your burden on the family, your burden on the caregivers, your burden on the patients, and the burden on the men because they are ones who have to say, "Lawd God I can't go near her when it's her time."

Dr Longmore-Dropinski is set on contributing to the ongoing transformation of psychiatry which she believes is no longer what it used to be in the past, when most persons tended to shy away from studying it. Although she didn't plan to enter this field when she first enrolled in medical school at the age of 17, she fell in love with this aspect of medicine about four years ago.

"My instrument is my pen and my mind and I am not as exposed to the physical, you know the blood and the gore and all of that," she said before adding, "The fact that I chose women's issues is the fact that nothing has been given to this as a priority in our setting, and I think it is something that we all need to pay attention to in managing mental issues."

Dr Longmore-Dropinski has ventured into obstetrics and gynaecology, surgery, radiography, ophthalmology and paediatrics since leaving medical school at 22 years old, but she said she got bored with each after a while. Psychiatry, she believes, allows her to practise preventative medicine and it places her in a highly sophisticated lab where she is always challenged through the unearthing of new things and the analysis of her patients.

"I loved paediatrics, but I realise that when I see cases of abuse, I get too angry and I would get myself in trouble," she shared.

The doctor has also worked with organisations such as UNESCO and UNDP where she assessed human development issues, especially those relating to women and children. She hopes to one day establish her private practice so she can further analyse mental issues affecting primarily females.

For those women who experience psychotic tendencies around their time of the month, she advises them to exercise and engage in less stressful activities as well as to go to a doctor, speak with a friend or tune in to a local talk show that deals with medical issues. The men, too, she said, have a role to play.

"The men can be supportive, the men can be understanding, the men can say to the lady, 'hello darling, you know that around this time, you are kind of hard to deal with still, you might need to go and get that checked out," she said.

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