Prevention of recurrent menstrual psychosis by an oral contraceptive

A 21-year-old unmarried female, with a history of periodic psychotic behavior, was admitted to the hospital after exhibiting overt psychotic symptoms. Several months of hospital observtion and a review of her earlier psychotic episodes suggested that the patient's psychotic behavior was associated with the onset of menses. The symptoms disappeared after oral contraceptives were administered on a regular basis. The patient experienced her 1st psychotic episode 1 year after menache. Several episodes during the intervening years required hospitalization. One of these episodes occurred during a period of prolonged menstrual flow. The patient's menstrual cycles were frequently irregular. During the present hospitalization the patient exhibited psychotic symptoms at the onset of 3 of her 4 menstrual cycles. She became agitated and delusional and exhibited dissociated thought patterns and autonomic symptoms. Despite the use of high doses of antipsychotic drugs, the symptoms persisted until the menstrual flow stopped 7 days later. After the 3rd episode the patient did not menstruate for 2 months. 69 days after the onset of her last menstrual flow the patient was given Provera to induce menstruation. 5 days later the menstrual flow began and Ortho-Novum 1/50 was administered. During the next 6 months she took the contraceptive regularly and remained free of any overt symptoms. The mechanism by which oral contraceptives prevent menstrual psychosis is unknown. Perhaps the estrogen decreases monoamine oxidase activity which in turn alters the level of norepinephine at the synapses.