A 27-year-old woman reports severe irritability, mood swings, anxiety, and breast tenderness occurring predictably during the week before menses and resolving within a few days of menstruation, in most cycles over the past year. The symptoms impair her work performance. To confirm the diagnosis of premenstrual dysphoric disorder, what additional step is required?
- A Prospective daily rating of symptoms over at least two symptomatic cycles ✓
- B Serum progesterone measurement during the luteal phase
- C Pelvic ultrasound to exclude ovarian pathology
- D Trial of combined oral contraceptives before confirming the diagnosis
Correct answer: A. Prospective daily rating of symptoms over at least two symptomatic cycles
Explanation
PMDD requires prospective confirmation: daily symptom ratings across at least two menstrual cycles must show symptoms confined to the luteal phase with remission shortly after menses onset, plus functional impairment. Retrospective recall overestimates premenstrual symptoms and cannot distinguish PMDD from a chronic mood disorder. Hormonal assays and imaging play no role in establishing the diagnosis, and a contraceptive trial is a treatment step, not a diagnostic one.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.