Sonntag, 20. Mai 2012

"Prämenstruelles Syndrom" als Beispiel für Medikalisierung

PMDD  - Premenstrual Dysphoric Disorder
= Prämenstruelles Syndrom

2 Sarafem Fernsehspots

Das Medikament mit dem Markennamen Sarafem enthält die Susbtanz Fluoxetin.
Fluoxetin ist ein Serotonin-Wiederaufnahmehemmer (SSRI). Fluoxetin wird als Antidepressivum in den USA mit dem Markennamen Prozac angeboten, in Deutschland als Fluctin bzw. als Generikum.

"Prämenstruelles Syndrom" ist ein typisches Beispiel für die medizinische Definition eines wohl doch eher als natürlich und normal zu betrachtenden Phänomens. 
s.a. Lehrbuch Sozialmedizin Abschnitt 4.3.2 (S.109 ff.)

PMDD ist nicht im im DSM IV und im ICD 10 enthalten.
Im Entwurf für das DSM V ist PMDD unter D 04 folgendermaßen beschrieben:

Premenstrual Dysphoric Disorder 

A.    In the majority of menstrual cycles, the following symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses. At least one of the symptoms must be either (1.), (2.), (3.), or (4.) below and the individual must experience at least five total symptoms:
1.    marked affective lability (e.g., mood swings; feeling  suddenly sad or tearful or increased sensitivity to rejection)
2.    marked irritability or anger or increased interpersonal conflicts
3.    marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
4.    marked anxiety, tension, feelings of being "keyed up" or "on edge"
5.    decreased interest in usual activities (e.g., work, school, friends, hobbies)
6.    subjective sense of difficulty in concentration
7.    lethargy, easy fatigability, or marked lack of energy
8.   marked change in appetite, overeating, or specific food cravings
9.    hypersomnia or insomnia
10.  a sense of being overwhelmed or out of control
11. physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain
Note: The criteria above must have been met for most menstrual cycles that occured in the preceding year.

B.   The symptoms are associated with clinically significant distress or interferences with work, school, usual social activities or relationships with others (e.g. avoidance of social activities, decreased productivity and efficiency at work, school or home).

C.   The disturbance is not merely an exacerbation of the symptoms of another disorder, such as Major Depressive Disorder, Panic Disorder, Dysthymic Disorder, or a Personality Disorder (although it may co-occur with any of these disorders).

D.   Criteria A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (The diagnosis may be made provisionally prior to this confirmation).

E.   The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or another medical condition (e.g., hyperthyroidism).

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