Psychosis in polycystic ovary syndrome – dilemmas in management
| Published date | 02 March 2012 |
| Pages | 82-88 |
| Date | 02 March 2012 |
| DOI | https://doi.org/10.1108/20441281211208446 |
| Author | Rohit Gumber,Tracy Hobbs,Bridget Cryer‐Rolley,Asit Biswas |
| Subject Matter | Education,Health & social care |
Psychosis in polycystic ovary syndrome –
dilemmas in management
Rohit Gumber, Tracy Hobbs, Bridget Cryer-Rolley and Asit Biswas
Abstract
Purpose – Mental health problems, particularly psychotic symptoms, are associated with polycystic
ovary syndrome (PCOS) which may be linked to oestrogen signalling cascade following a period of
sustained high oestrogen and dysregulation of cortisol. This case report aims to demonstratea potential
link and improvement following the use of Metformin.
Design/methodology/approach – The paper describes a case of a female with intellectual disability
who presents with psychosis coinciding with PCOS and the aetiology of this association.
Findings – The case highlights some key points and complexities encountered in diagnosing and
managing an individual with mental and physical health issues and an underlay of family dynamics and
insecure attachment. A treatment approach involving recommendations from and joint working between
professional groups including endocrinology, is highlighted.
Originality/value – There are very few studies to date that link PCOS to psychosis and only a single
case report describes the use of Metformin. In a patient presenting with psychosis and PCOS,
the consideration of an association with hormonal changes should be made, especially in patients with
changing severity of psychosis and poor response to psychiatric medication. A ‘‘multimodal’’
intervention package needs to be considered for optimum benefit.
Keywords Polycystic ovary syndrome, Psychosis, Intellectual disability, Metformin, Mental illness,
Learning disabilities
Paper type Case study
Introduction
Kreapelin (1919) estimated that 7 per cent of cases of dementia praecox arose in individuals
with pre-morbid cognitive impairment, resulting in early onset psychosis, which he called
‘‘Pfropfschizophrenie’’ (Doody et al., 1998). Historically, people with intellectual disability
were seen as being incapable of suffering froma discrete mental illness, and a dual diagnosis
of mental illness and mental retardation has been a source of controversy.However, it is now
known adults with intellectual disability exhibit the same type of psychiatric disorders as in the
general population, although accurate diagnosis is often difficult to make (Bouras et al., 2004;
Cherry et al., 2000). Deficits in language and impaired communication skills may hinder self-
reports of delusions, hallucinations and other symptoms of schizophrenia (Bresch, 2004;
Morgan et al., 2008). Furthermore, behavioural disturbances which may indicate mental
illness in an individual with normal intelligence, may have other explanations in individuals with
intellectual disability (Duggan and Brylewski, 1999).
Polycystic ovary syndrome (PCOS) is common, affecting 5-10 per cent of women of
childbearing age (Levenson, 2006). It is characterised by both gynaecological and
endocrine symptoms, including anovulatory cycles, hyperandrogenism, insulin resistance
and metabolic syndrome. Effects on physical appearance include obesity, hirsutism, acne
and hair loss (Norman et al., 2007; Elsenbruch et al., 2006). There have been reports of a link
between psychiatric symptoms and the menstrual cycle, and between mood changes
PAGE 82
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 6 NO. 2 2012, pp. 82-88, QEmerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/20441281211208446
Rohit Gumber is a
Speciality Trainee 5 at
Leicestershire Partnership
NHS Trust, Leicester, UK.
Tracy Hobbs is a Learning
Disability Nurse at
Winstanley Drive Health
Centre, Leicester, UK.
Bridget Cryer-Rolley
is a Consultant
Psychologist and
Asit Biswas is a Consultant
Learning Disability
Psychiatrist, both at
Leicestershire Partnership
NHS Trust, Leicester, UK.
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