O693 Montreal consensus on definition, measurement and diagnosis of premenstrual disorders

Abstract

Objectives: The International Society for Premenstrual Disorders (ISPMD) was convened to address definition, diagnosis, measurement and clinical trial design. Methods: Eighteen experts considered published and new evidence on self report techniques, biochemical/endocrine markers, physical & genetic markers, saccadic eye velocity, functional MRI, PET scanning, Proton Magnetic Resonance Spectroscopy. A quasi-Delphi method was used to establish consensus. Results: The “core” disorder depends on ovulation. “Ovarian activity”, oral contraception, gestogen (in HRT) were recognised to produce similar symptoms which can equally be physical or psychological. Pre-menstrual symptoms are considered physiological if they are not troublesome. Symptoms must be of sufficient severity to have a major impact on normal functioning to be considered as PMS/PMDD. Premenstrual Syndrome can be mild, moderate or severe. The severe psychological extreme of the PMD spectrum equates to Premenstrual Dysphoric Disorder (PMDD). Ovulation may also cause premenstrual exacerbation of physical, medical, psychological and psychiatric disorders. Objective technique to define premenstrual disorders have not been identified. The Daily Record of Severity of Problems (DRSP) has been the main technique for research studies. Clinical trial design was agreed, establishing duration of therapeutic and placebo arms and the desirability of initial placebo washout. Conclusion: Clarity had been achieved by ISPMD. Results should be brought to the attention of specialist and health bodies, especially APA (currently revising classifications in DSM V) and WHO (currently re-visiting describing ICD 11).