Childhood adversity predicts stronger premenstrual mood worsening, stress appraisal and cortisol decrease in women with Premenstrual Dysphoric Disorder

BackgroundLifetime traumatic events are prevalent in women with Premenstrual Dysphoric Disorder (PMDD) and predict stronger premenstrual symptom intensities. Less is known about the unique effects of childhood adversity on PMDD. This study aims to investigate the menstrual cycle related course of mood, stress appraisal and cortisol activity over time and the effects of childhood adversity – by controlling for recent stressful life events – on the cyclicity of these outcomes.MethodsFifty-two women with PMDD completed questionnaires on childhood adversity and stressful life events during the past 12 months. Momentary negative and positive affect, stress appraisal, and saliva-cortisol were assessed within an Ambulatory Assessment (AA) design over four consecutive days during both the follicular and the late luteal phase. This AA was repeated after five months, resulting in two measurement bursts.ResultsWomen with PMDD showed expected cycle related variations in mood and stress appraisal, whereby these effects weakened over time. No cortisol cyclicity was identified. Higher childhood adversity was linked to stronger increases in negative affect and stress appraisal, and stronger decreases in positive affect from the follicular toward the late luteal phase. Women with higher childhood adversity exhibited lower cortisol levels during the late luteal phase compared to the follicular phase whereas no such cyclicity was found in women with lower childhood adversity.ConclusionChildhood adversity appears to show independent deteriorating effects on premenstrual mood worsening and stress appraisal in women with PMDD. The observed cortisol cyclicity in women with higher childhood adversity may point to different neuroendocrine subtypes of PMDD in relation to childhood trauma and requires further systematic research

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps

Purpose of Review: In contrast to premenstrual dysphoric disorder (PMDD), premenstrual exacerbations (PMEs) of ongoing mood disorders are understudied. The aim of this review is to describe diagnostic issues, epidemiology, underlying mechanisms, and treatment for PME in unipolar depression and bipolar disorder, and to discuss clinical and research implications. Recent Findings: Community-based and clinical studies estimate that in women with mood disorders around 60% report PME, while some women with bipolar disorder also show symptom exacerbations around ovulation. In general, PME predicts a more severe illness course and an increased burden. While heightened sensitivity to fluctuations of sex hormone levels across the menstrual cycle appears to contribute to PME and PMDD, the overlap of their underlying biological mechanisms remains unclear. Beneficial treatments for PMDD show less or no efficacy in PME. Pharmacological treatments for PME in mood disorders predominantly seem to profit from adjustable augmentation of treatment dosages during the luteal phase for the underlying disorder. However, the evidence is sparse and mainly based on earlier small studies and case reports. Summary: Previous research is mainly limited by the lack of a clear differentiation between PME and PMDD comorbidity with mood disorders. More systematic research with uniformly defined and prospectively assessed subgroups of PME in larger epidemiological and clinical samples is needed to receive reliable prevalence estimates and information on the clinical impact of PME of mood disorders, and to uncover underlying mechanisms. In addition, larger randomized controlled trials are warranted to identify efficacious pharmacological and psychotherapeutic treatments for affected women

Induced Rumination and Mindful Self-focus in Daily Life across the Menstrual Cycle in Women with and without Premenstrual Dysphoric Disorder

Rumination and mindfulness are transdiagnostic risk and protective factors while their role in Premenstrual Dysphoric Disorder (PMDD) is unclear. Thus, we aimed to investigate the cycle-phase-specific effects of rumination and mindful self-focus on momentary mood and cognitions in women with and without PMDD. This study involved brief ambulatory inductions of rumination and mindful self-focus along with ambulatory assessments of negative (NA) and positive affect (PA), and rumination, present-moment-awareness (PMA) and self-acceptance on two days during both the follicular and late luteal phase in women with and without PMDD (n = 60 each). Compared to healthy controls, women with PMDD showed stronger increases in PA in response to mindful self-focus inductions during the late luteal phase, whereas no such group differences were identified during the follicular phase. Independent of clinical status and cycle phase, induced rumination immediately increased momentary NA and rumination and decreased PMA, whereas induced mindful self-focus inductions increased momentary self-acceptance. Overall, higher PA-reactivity toward mindful self-focusing during late-luteal-phase-specific in women with PMDD points to the potential of cycle-phase-specific mindfulness interventions for PMDD. Irrespective of cycle phase, rumination and mindfulness appear to represent targets for brief prevention and intervention measures for both non-clinical and clinical groups

Associations between adverse childhood family environments and blood pressure differ between men and women.

BackgroundIt is unclear how adverse childhood family environments differentially impact adult health outcomes among men and women. This brief communication reports on the independent and joint effects of adverse childhood family environments and sex on indicators of health in adulthood.Methods & results213 18-55-year olds reported on their childhood family environment (Risky Families Questionnaire (RFQ); Family Environment Scale (FEStotal)) and their current perceived stress and depressive and anxious affect. Resting systolic (SBP) and diastolic blood pressure (DBP), and heart rate (HR) were taken during a laboratory visit, and total cortisol output was measured in saliva samples collected at home. Exposure to childhood adversity did not vary by sex. Women had lower SBP, DBP, and total cortisol output, but higher HR, than men (ps ConclusionsContrary to expectations, exposure to adverse childhood family environments was associated with lower resting BP among women, perhaps indicative of basal cardiovascular hypoactivation, whereas early adversity was not linked to BP among men

State and trait cognitions differentially affect cyclicity of mood and cortisol in women with and without Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) is characterized by a cyclical symptom course. Previous research provides limited findings on possible menstrual-cycle-related psychological and psychoen-docrinological processes in PMDD. By using Ambulatory Assessment (AA), we aimed to compare mood and cortisol cyclicity in women with PMDD and healthy controls (HC), and to assess effects of habitual and momentary repetitive-negative-thinking (RNT) and present-moment-awareness (PMA) on mood and cortisol across the cycle in both groups. Women with PMDD and HCs (n = 60 each) completed baseline questionnaires on habitual RNT and PMA. Momentary rumination and PMA, positive and negative affect, and saliva-cortisol were assessed over four consecutive days during both the follicular and the late-luteal phase. Women with PMDD showed mood cyclicity indi-cating mood worsening while HCs showed cortisol cyclicity indicating decreasing cortisol levels to-ward the late-luteal phase. In women with PMDD, lower habitual RNT and higher habitual PMA predicted better mood only during the follicular phase whereas lower momentary rumination and higher momentary PMA predicted better mood during the late-luteal phase. No effects on cortisol activity were found. In HCs, higher habitual PMA predicted lower negative affect during the late-luteal phase whereas lower momentary rumination and higher momentary PMA predicted strong-er cortisol reduction toward the late-luteal phase. While favorable habitual cognitions might not protect women with PMDD against premenstrual mood deterioration, respective momentary cog-nitions may reflect possible protective factors, suggesting an opportunity for micro-interventions to directly target late-luteal-phase-specific state processes in affected women. The lack of cortisol cyclicity might represent an endocrinological marker for PMDD