A 29-year-old woman reports mood swings, irritability, breast tenderness, and bloating in the week before menses for the past year, with full functional recovery once bleeding starts. To confirm a diagnosis of premenstrual dysphoric disorder, what additional step is essential?

• A Serum estradiol and progesterone levels during the luteal phase
• B A trial of combined oral contraceptives with documented response
• C Thyroid function tests to exclude hypothyroidism
• D Prospective daily symptom ratings across at least two consecutive menstrual cycles ✓

Explanation

PMDD diagnosis requires prospectively documented daily ratings over at least two symptomatic cycles confirming that symptoms are confined mainly to the luteal phase and remit around menses onset. Retrospective recall overestimates symptoms and cannot confirm the cyclical pattern. Hormone assays and thyroid tests may be done to exclude mimics but do not establish the diagnosis, and response to a therapeutic trial is not a diagnostic criterion.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.