PMS Neuropsychiatric Consultation Group - ECHO

Depression is a spell of days to weeks or months during which a person

• Loses interest in things they used to enjoy
• May seem withdrawn and not respond as they usually do to affection or playfulness
• Sleeps more
• Moves slowly
• May look sad
• May look fearful
• May be irritable or grumpy
• Has changes in their interest in food, eating more or less than usual

Mania is a spell of days to weeks or months during which a person

• Sleeps less than usual and doesn’t seem tired even though they did not sleep much
• Has high energy and moves around more than usual
• May talk or vocalize more, faster, or more loudly than usual
• May be excited, extra happy, or irritable, and react faster than usual
• Pursues things they like intensely
• Does impulsive or dangerous things they don’t usually do (this can include sexual behaviors, stripping off clothes, bolting away, climbing unsafely)
• May have intense repeating of behaviors such as taking things off shelves and strewing them around

Anxiety Disorders are diagnosed when a person has fears and behaviors that interfere with their usual function. This can be hard to clarify for our families, because:

1. repetitive behaviors and obsessions with favorite objects and experiences such as videos are common in people with PMS as part of the syndrome, and
2. people who can’t use language well can’t always let us know when they’re frightened. Some people with PMS also develop new, intense difficulties in teen or adult years that may earn them new diagnoses.

Symptoms include:

• Refusal to go places or see people that they used to enjoy
• New fears
• Irritability and trouble settling to sleep
• Agitated behavior with attempts to “escape” or frantic grabbing at caregivers that may be due to panic
• New intense need to get hold of things they like (dolls, cars etc)
• New need to do things in exact sequence or to do things over and over
• Repeated questions and looking for reassurance about worries that don’t seem to be soothed by answers
• Restlessness, diarrhea, trembling or pallor that are related to adrenaline

Catatonia is an unusual disturbance of motor functions, often accompanied by some signs of fear, that can happen during a spell of psychiatric illness, or can happen in response to medical stress or to certain medications that might be used to treat other problems. People with PMS may be more likely to develop catatonia when treated with anti-psychotic drugs than others are. 

Catatonia can take a form of immobility (“stuporous catatonia”) or of greatly agitated, restless behavior with repeated movements and oppositional, negative reactions (this kind is known by several names, including “excited catatonia”, “delirious mania” or “hyperactive catatonia”). 

Catatonia can be dangerous, and can increase to a level which requires ICU care. Some of the symptoms listed here are things that may be part of how a person with PMS always has been; these do not count towards a catatonia diagnosis. These symptoms only suggest catatonia if they’re new or very different from how the person was before. Some symptoms of catatonia that have been described in people with PMS include:

• Stiff and rigid muscles
• New ways of walking or of holding the body, such as leaning over or to the side, holding arms bent, or walking in circles
• Holding awkward, uncomfortable-looking positions for a long time as if “stuck”
• Staring and not responding for long periods
• Having trouble crossing boundaries, going up stairs, getting into and out of cars
• Frequent trips to the bathroom with nothing coming out
• Repeating and echoing behaviors (new ones) such as repeating words, phrases or body motions
• Resistant, oppositional behavior that is not part of how the person usually is
• Difficulty using their mouth and tongue as they usually do, with slurred speech, drooling, or not moving food around in the mouth to chew and swallow it
• Turning away and refusing food
• Grimacing (odd facial expressions)

Psychosis is a state of confused or disoriented thinking and behavior. Symptoms include:

• Seeing or hearing things that others don’t (in non-verbal people we have to guess by watching their behavior – are they responding to or watching things we can’t see?)
• Sudden outbursts of dangerous, apparently meaningless behavior that’s very out of character for the person
• Expressing beliefs that are new and don’t make sense, such as thinking that there are monsters outside 

Regression is a word that is used in different ways, and a big concern for PMS parents. Some children lose skills in their early years – usually before age 6 years – and this is a known part of the syndrome and of autism generally. There are also some people with PMS who lose skills later in childhood or in teen and adult years. It is important to watch to see if the loss of skill comes and goes with episodes of illness, or whether it lasts for months when the person is not ill.