Atypical episodes of dissociation in an adolescent female - possible relationship with the menstrual cycle

Introduction Psychiatric symptoms related with menstrual cycle vary from dysphoria to psychosis. There are only a few cases of menstrual psychosis reported, all characterized by acute onset, against a background of normality, brief duration, with full recovery and a circa-mensual periodicity. Objectives We report a case of dissociative disorder, in a teenage girl, with atypical presentation and an unusual periodicity of symptoms and recoveries. Methods Presentation of a case of dissociative disorder, followed by a review of the similar cases described in the literature. Results We are presenting a case of a 15 years old female, who presented in our Emergency Department for confusion, anxiety, negativism in verbal and non-verbal response, bradylalia and bradypsychia, insomnia for over 48 hours. The symptoms suddenly began two days before arrival in our clinic. From the patient’s personal history, we retain the following: menarche at 14 years old, irregular periods, hypermenorrhea. Patient was born premature, G=1200g, spastic diplegia, periventricular leukomalacia (MRI – 2018). Three similar episodes happened a year ago, with one month periodicity, with spontaneous remission after 5-6 days. Patient was treated with antipsychotics and benzodiazepines for the second and the third episode, but the treatment was stopped six month ago. The investigations results were normal, except for a high level of plasmatic cortisol. Patient fully recovered in the day the menses stopped. Conclusions We considered this case to be atypical due to the sudden debut and recovery and there are still some remaining questions. Is it hormonal related, menstrual related or is it exclusively a psychiatric condition? Disclosure No significant relationships.